Optimal Medical Therapy Targeting Metabolic Status for Secondary Prevention in Patients Undergoing Percutaneous Coronary Intervention

Forzano, Imma; Narciso, Viviana; Canonico, Mario Enrico; Castiello, Domenico Simone; Florimonte, Domenico; Manzi, Lina; Semplice, Federica; Vallone, Donato Maria; Cristiano, Stefano; Spinelli, Alessandra; D’Alconzo, Dario; Paolillo, Roberta; Giugliano, Giuseppe; Cesaro, Arturo; Gragnano, Felice; Calabrò, Paolo; Esposito, Giovanni; Gargiulo, Giuseppe

doi:10.3390/jcm15031108

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Optimal Medical Therapy Targeting Metabolic Status for Secondary Prevention in Patients Undergoing Percutaneous Coronary Intervention

by

Imma Forzano

^1,†,

Viviana Narciso

^1,†

,

Mario Enrico Canonico

^1,2

,

Domenico Simone Castiello

¹

,

Domenico Florimonte

¹

,

Lina Manzi

¹,

Federica Semplice

¹,

Donato Maria Vallone

¹,

Stefano Cristiano

¹

,

Alessandra Spinelli

¹,

Dario D’Alconzo

¹,

Roberta Paolillo

¹

,

Giuseppe Giugliano

¹

,

Arturo Cesaro

^3,4

,

Felice Gragnano

^3,4

,

Paolo Calabrò

^3,4

,

Giovanni Esposito

¹

and

Giuseppe Gargiulo

^1,*

¹

Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy

²

CPC Clinical Research, Department of Medicine, University of Colorado, Aurora, CO 80045, USA

³

Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy

⁴

Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”, 26100 Caserta, Italy

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

J. Clin. Med. 2026, 15(3), 1108; https://doi.org/10.3390/jcm15031108

Submission received: 24 December 2025 / Revised: 25 January 2026 / Accepted: 28 January 2026 / Published: 30 January 2026

(This article belongs to the Special Issue Advances and Future Directions in Percutaneous Coronary Intervention (PCI))

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Abstract

Cardiovascular disease remains the leading cause of death and disability worldwide. Coronary artery disease is the most common clinical manifestation. The underlying pathology is largely attributable to atherosclerosis, a chronic inflammatory process that results in the development of atherosclerotic plaques. Coronary artery disease may present as chronic coronary syndrome or acute coronary syndrome, depending on the extent and stability of plaque disruption. The risk of cardiovascular events is modulated by established clinical and metabolic factors, and risk stratification frameworks are provided by international guidelines. Patients undergoing percutaneous coronary intervention are classified as being at very high cardiovascular risk, despite improvements in invasive and non-invasive management. In this population, the residual ischemic risk remains a significant concern, underscoring the need for targeted secondary prevention strategies. The secondary prevention addresses modifiable risk factors, including hypertension, dyslipidemia, diabetes mellitus, overweight and obesity, and tobacco use, along with recommendations for lifestyle modification. Nonetheless, current interventions leave a substantial proportion of patients exposed to future events, indicating a persistent unmet therapeutic need. Emerging evidence highlights the critical roles of lipid metabolism, inflammation, and metabolic dysfunction in the residual risk pathophysiology. This narrative review aims to examine pharmacological strategies targeting metabolic pathways, notably obesity and diabetes, in the context of secondary cardiovascular prevention in patients undergoing percutaneous coronary intervention.

Keywords: coronary artery disease (CAD); secondary prevention; percutaneous coronary intervention (PCI); acute coronary syndrome (ACS); chronic coronary syndrome (CCS); metabolic status; obesity; diabetes

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MDPI and ACS Style

Forzano, I.; Narciso, V.; Canonico, M.E.; Castiello, D.S.; Florimonte, D.; Manzi, L.; Semplice, F.; Vallone, D.M.; Cristiano, S.; Spinelli, A.; et al. Optimal Medical Therapy Targeting Metabolic Status for Secondary Prevention in Patients Undergoing Percutaneous Coronary Intervention. J. Clin. Med. 2026, 15, 1108. https://doi.org/10.3390/jcm15031108

AMA Style

Forzano I, Narciso V, Canonico ME, Castiello DS, Florimonte D, Manzi L, Semplice F, Vallone DM, Cristiano S, Spinelli A, et al. Optimal Medical Therapy Targeting Metabolic Status for Secondary Prevention in Patients Undergoing Percutaneous Coronary Intervention. Journal of Clinical Medicine. 2026; 15(3):1108. https://doi.org/10.3390/jcm15031108

Chicago/Turabian Style

Forzano, Imma, Viviana Narciso, Mario Enrico Canonico, Domenico Simone Castiello, Domenico Florimonte, Lina Manzi, Federica Semplice, Donato Maria Vallone, Stefano Cristiano, Alessandra Spinelli, and et al. 2026. "Optimal Medical Therapy Targeting Metabolic Status for Secondary Prevention in Patients Undergoing Percutaneous Coronary Intervention" Journal of Clinical Medicine 15, no. 3: 1108. https://doi.org/10.3390/jcm15031108

APA Style

Forzano, I., Narciso, V., Canonico, M. E., Castiello, D. S., Florimonte, D., Manzi, L., Semplice, F., Vallone, D. M., Cristiano, S., Spinelli, A., D’Alconzo, D., Paolillo, R., Giugliano, G., Cesaro, A., Gragnano, F., Calabrò, P., Esposito, G., & Gargiulo, G. (2026). Optimal Medical Therapy Targeting Metabolic Status for Secondary Prevention in Patients Undergoing Percutaneous Coronary Intervention. Journal of Clinical Medicine, 15(3), 1108. https://doi.org/10.3390/jcm15031108

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