J Cardiovasc Interv.  2024 Jul;3(3):119-135. 10.54912/jci.2024.0006.

“East Asian Paradox” Revisited: Precision Medicine for Antithrombotic Strategies Tailored to Atherothrombotic Cardiovascular Risks

• Jeong YH
• Tantry US
• Omar M
• Navarese E
• Gorog DA
• Gurbel PA

• KMID: 2561211
• DOI: http://doi.org/10.54912/jci.2024.0006

Abstract

Following percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD), patients may face a prolonged elevated risk of atherothrombotic events. This enduring vulnerability underscores the need for refined secondary prevention strategies, grounded in a deepening understanding of the pathobiology involved. The shift in CAD pathophysiology research from focusing on ‘vulnerable plaques’ to embracing the concept of the ‘vulnerable patient’, emphasizing the essential role of medical therapy in secondary prevention. Despite the current guideline-directed medical therapy, a consistent proportion of post-PCI patients experience recurrent atherothrombotic events due to unaddressed ‘residual atherothrombotic cardiovascular (CV) risks’. Contemporary clinical research highlights the pivotal role of lipid phenotype, systemic inflammation, glycemia, platelets, coagulation, and fibrinolytic activity, advocating for a more personalized, targeted therapeutic approach. Balance between clinical efficacy and safety during antithrombotic agents may be different according to ‘residual atherothrombotic CV risks’. Blacks generally exhibits the highest level of atherothrombotic CV risks, followed by Hispanics and Caucasians with comparable levels, and finally the lowest level is observed in East Asians, which will be a major factor supporting the ‘East Asian Paradox’. In this review, we discuss available evidence regarding the racial differences in atherothrombotic CV risks and its impact on clinical post-PCI outcomes to determine precision medicine for antithrombotic strategies.

Keyword

Coronary artery disease; Thrombosis; Cardiovascular risk; Race; Antithrombotic agent