2026-10-14T05:34:14Z https://api.figshare.com/v2/oai

oai:figshare.com:article/34009569 2026-09-28T05:44:47Z category_140 portal_316 item_type_3 month_year_09_2026

Table 1_Residual atherosclerotic cardiovascular disease risk in statin-treated patients: mechanisms, therapeutic strategies, and future directions—a scoping review.docx Muhammad Abdul Rehman (9147806) Malik Olatunde Oduoye (19855059) Davidson John Ozoemena (25120158) Edward Akosah Danso (23754831) Gabriel Chukwuka (25120161) Mary Abosede Odelade (25120164) Cardiology inflammation lipid-lowering therapy lipoprotein(a) low-density lipoprotein cholesterol precision cardiovascular medicine residual atherosclerotic cardiovascular disease risk statins Background<p>Statins remain the cornerstone of pharmacological prevention for atherosclerotic cardiovascular disease (ASCVD) because of their proven ability to reduce low-density lipoprotein cholesterol (LDL-C) and major adverse cardiovascular events (MACE). However, many patients continue to experience ASCVD events despite achieving guideline-recommended LDL-C targets with maximally tolerated statin therapy, highlighting the persistence of residual ASCVD risk. This scoping review synthesized current evidence on residual ASCVD risk in statin-treated patients, focusing on its epidemiology, underlying mechanisms, clinical evidence, therapeutic strategies beyond statins, and barriers to optimal risk reduction.</p>Methods<p>A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Electronic databases were systematically searched, yielding 1,240 records. After duplicate removal and screening, 195 full-text articles were assessed for eligibility, and 35 studies were included in the final qualitative synthesis. The included evidence comprised randomized controlled trials, observational cohort studies, registry-based investigations, and systematic and narrative reviews.</p>Results<p>The included studies were synthesized into five major themes: epidemiology of residual ASCVD risk, underlying mechanisms, clinical evidence from landmark trials and real-world studies, therapeutic strategies beyond statins, and challenges limiting effective risk reduction. Evidence consistently demonstrated that residual ASCVD risk persists despite substantial LDL-C reduction because of multiple interacting factors, including elevated triglyceride-rich remnant lipoproteins, lipoprotein(a), persistent inflammation, metabolic comorbidities, vascular aging, treatment-implementation barriers, and behavioral factors. Landmark clinical trials, including IMPROVE-IT, FOURIER, ODYSSEY OUTCOMES, REDUCE-IT, CANTOS, LoDoCo2, and CLEAR Outcomes, demonstrated incremental cardiovascular benefit from combination lipid-lowering and selected anti-inflammatory therapies, while emerging therapies targeting lipoprotein(a), IL-6 signaling, and RNA-based pathways offer promising strategies for further reducing residual ASCVD risk.</p>Conclusion<p>Residual ASCVD risk remains a major challenge despite guideline-directed statin therapy. Effective risk reduction requires a comprehensive approach that extends beyond LDL-C lowering to include combination lipid-lowering therapy, inflammation-targeted interventions, lifestyle optimization, improved treatment adherence, and individualized risk assessment. Continued evaluation of emerging therapies and precision medicine approaches is essential to further reduce the global burden of ASCVD.</p> 2026-09-28T05:44:47Z Dataset Dataset 10.3389/fcvm.2026.1911458.s001 https://figshare.com/articles/dataset/Table_1_Residual_atherosclerotic_cardiovascular_disease_risk_in_statin-treated_patients_mechanisms_therapeutic_strategies_and_future_directions_a_scoping_review_docx/34009569 CC BY 4.0