Panminerva Medica 2021 Jun 01

DOI: 10.23736/S0031-0808.21.04284-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

How to fill the GAPS-I in secondary prevention: application of a strategy based on GLP1 analogues, antithrombotic agents, PCSK9 inhibitors, SGLT2 inhibitors and immunomodulators

Pierre SABOURET ¹ ✉, Denis ANGOULVANT ², Atul PATHAK ⁴, Marinos FYSEKIDIS ³, Giulia LATERRA ⁵, Francesco COSTA ⁵, Gilles MONTALESCOT ¹, Giuseppe BIONDI-ZOCCAI ^{6, 7}

¹ Cardiology Institute, Pitié Salpêtrière Hospital (AP-HP), INSERM UMRS 1166, ACTION Study Group, Sorbonne University, Paris, France; ² Cardiology Department, Loire Valley Cardiovascular Collaboration & EA4245, CHRU de Tours & Tours University, Tours, France; ³ Department of Diabetology, Hôpital Universitaire Avicenne, Bobigny, France; ⁴ Department of Cardiovascular Medicine, Clinique Pasteur, INSERM 1048, Toulouse, France; ⁵ Cardiology Department, Messina University, Messina, Italy; ⁶ Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; ⁷ Mediterranea Cardiocentro, Naples, Italy

The continuous progress in cardiovascular (CV) risk prevention strategies has led to an impressive reduction in mortality and recurrent ischemic events in patients with coronary artery disease (CAD). However, the control of several CV risk factors remains suboptimal in many CAD patients, with a high rate of recurrent events, underlying the need for more new prevention strategies. The GAPS-I (GLP1 analogues, Antithrombotic agents, PCSK9 inhibitors, SGLT2 inhibitors and Immunomodulators) strategy offers a promising potential in patients with a high-residual CV risk, who are frequently encountered in daily practice, by offering an individualised and structured approach to addressing their individual risk factors. The current review summarises the evidence to date on each of its components, with respect to clinical outcomes and economic feasibility. The current evidence points to an efficacy of GAPS-I in reducing MACE and mortality, without a compromise on safety, albeit with the need for longer follow-up data. Key Points: - Secondary prevention remains suboptimal in many CAD patients, highlighting the need for innovative prevention strategies. - The present review discusses the current evidence on efficacy of the GAPS-I strategy in reducing MACE and mortality in patients with CAD. - The GAPS-I strategy, if widely adopted, provides a promising potential to assist cardiologists in managing patients at a heightened risk for further CV events.

KEY WORDS: Residual risk; Dyslipidemia; Diabetes; Lipid lowering treatments; Cardiovascular diseases