Secondary prevention definition
prevention actions taken after the development of disease to halt its progress and subsequent complications
Major goals of secondary prevention of CVD
o Goal #1: Prevention of plaque rupture and progression o Goal #2: Prevention of new plaque formation
Major categories of tools used in secondary prevention of CVD
-medications: rely on health care system (and compliance) -lifestyle changes: rely’s mainly on patient and built environment
Main pharmacologic secondary CVD prevention guidelines
-anti-platelets -beta-blockers -RAAS inhibitors
Main pharmacologic+lifestyle secondary CVD prevention guidelines
-Blood pressure control -Lipid management -Diabetes management -Depression screening and treatment -Smoking cessation
Main lifestyle secondary CVD prevention guidelines
-weight management -physical activity
Other possible secondary CVD prevention guidelines
-cardiac rehabilitation -influenza vaccination
Anti-platelets used in secondary CVD and rationale
-Anti-platelets prevent platelet adhesion to the site of a ruptured plaque, reduce platelet activation, and prevent platelet aggregation -Aspirin -Thienopyridines
Thienopyridines MOA & examples
(clopidogrel, ticlodipine, prasugrel, and ticagrelor) Inhibits adenosine diphosphate (ADP) production and platelet aggregation
Aspirin MOA
Reduces platelet activation by blocking cyclooxygenase and thromboxane A2 (a vasoconstrictor) production
Class I Antiplatelet guidelines
- ALL CAD patients: asprin daily
- PTS w/ACS or PCI for one year following the event: Thienopyridines + aspirin
- PTS post-bypass surgery: aspirin (at least one year)
- PTS post-stroke: aspirin alone, clopidogrel alone, or combined aspirin/dipyridamole daily chronically
- PTS w/symptomatic peripheral arterial disease: aspirin alone or clopidogrel alone
- PTS w/warfarin: continue low-dose aspirin and monitor closely for bleeding
Class I beta-blocker guidelines
Beta-blockers in all with LVSD (ejection fraction <40%) and heart failure symptoms or MI/ACS in the prior 3 years
Class IIa beta-blocker guidelines
- Beta-blockers in all with LVSD (ejection fraction <40%) even in the absence of heart failure symptoms
- Beta-blockers in all with any history of MI/ACS
Class I RAAS inhibition guidelines
- ACEIs
- All with LVSD (ejection fraction <40%), DM, HTN, or chronic kidney disease
- ARBs
- All with LVSD (ejection fraction <40%) and either a prior MI or heart failure symptoms and who are ACEI-intolerant
- Aldosterone inhibition
- Post-MI patients with LVSD (ejection fraction <40%) on BB and ACEI/ARB w/heart failure or diabetes.
- Avoid in those with renal dysfunction or significant hyperkalemia
Class I BP control guidelines
- Age <60yo: BP <140/90
- Age ≥60yo: BP <150/90
Class I lipid guidelines
- Statins in ALL CAD patients
- No need to titrate to LDL
- No indication for non-statin lipid-lowering therapies
- Not proven in HF NYHA Class III-IV or hemodialysis patients
Class I diabetes guidelines
-lifestyle modifications -coordination w/PCP
Class IIa/IIb diabetes guidelines
- IIa: metformin=first-line pharm therapy
- IIb: HbA1c <7% can be considered as goal
Class IIa/IIb depression guidelines
- IIa: assess depression
- IIb: tx may not improve cardiac outcomes but is at least beneficial to overall mental health
Class I smoking guidelines
Stop that shit.
Class I weight control guidelines
- Goal BMI is 18.5-24.9
- Goal waist circumference is <35 inches for women
- Initial goals of weight loss should be 5-10% of body weight
Class I physical activity guidelines
Just do it (mod-high intensity for 30-60 minutes/5-7 days/week)
