Secondary Prevention of Coronary Heart Disease Flashcards
(23 cards)
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)
