Essence of this Article
Other agents recommended for use in secondary prevention of acute coronary syndrome (ACS) include βblockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers; statins, aldosterone antagonists and vorapaxar. Patients who have experienced an ACS event are also advised to make lifestyle changes to reduce their overall cardiovascular risk, such as smoking cessation, regular physical activity, weight reduction and changes in diet.
The management of underlying disorders (e.g. hypertension, diabetes, dyslipidaemia) and other risk factors, through medical management and lifestyle changes, is an important part of secondary prevention strategies after ACS.
- βblockers – lower heart rate, blood pressure and contractility, which reduces myocardial oxygen consumption221
- ACE inhibitors – reduce ventricular remodelling and prevent further deterioration in ventricular performance in patients with reduced left ventricular systolic function after MI
- Angiotensin receptor blockers – also reduce ventricular remodelling
- Statins – benefits of reducing low-density lipoprotein levels with statins include plaque stabilization, restoration of endothelial function and anti-inflammatory effects
- Aldosterone antagonists – block the activation of mineralocorticoid receptors, which has adverse effects in cardiovascular disease
Although not currently included in any guideline recommendations, vorapaxar – a protease-activated receptor (PAR-1) antagonist has been approved by the US Food and Drug Administration for prevention of atherothrombotic events, added to standard of care, in patients with a history of MI and no history of stroke/transient ischaemic attack.556, 557
- Smoking cessation
- Regular physical activity
- Weight reduction in patients with high body mass index and/or large waist circumference
- Reduction in the intake of salt and saturated fat
- Increase in consumption of fruit, vegetables, wholegrain cereals, lean meat and fish