Emerging treatments
Colchicine
Guidelines provide a weak recommendation that the anti-inflammatory agent colchicine may be considered for select patients with CCD who are at high-risk of subsequent events despite maximum tolerated guideline-directed management and therapy.[26] Trials of long-term therapy (1 to 3 years) have shown reduction in a combined cardiovascular outcome with a trend towards reduced cardiovascular death counterbalanced by a trend towards increased non-cardiovascular death.[227][228] Limitations include gastrointestinal (GI) adverse effects (which prompted 10% withdrawal during the run in phase of the largest study) as well as a narrow therapeutic index, drug interactions, and the need for dose adjustments in renal impairment.[26][227] Further studies are required to guide clinical practice.
Other LDL-lowering therapies
Bempedoic acid and inclisiran are newer non-statin therapies approved for use with diet and maximally tolerated statin therapy in adults who require additional lowering of LDL-C.[229] They may be selectively considered for high risk patients with severely or persistently elevated LDL despite use of (or for those unable to use) better established alternatives. Trials assessing clinical outcomes are ongoing, with one trial showing benefit in statin-intolerant patients.[230][231][232]
Coronary-sinus-reducing device
A coronary-sinus-reducing device has shown some promise in the small COSIRA trial, improving symptoms and quality of life in patients with refractory angina who were not candidates for revascularisation.[233]
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