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

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.