Clinical Pharmacology of Stable Coronary Artery Disease

Question 1

How has the epidemiology of ACS changed over time?

Answer 1

Decline in mortality due to improved treatments and prevention.

Shift in risk factors → More ACS cases in people with diabetes, obesity, and metabolic syndrome.

Younger age groups affected → Due to lifestyle changes, smoking, and stress.

More cases in women and elderly as awareness improves.

Question 2

What are key risk factors for ACS?

Answer 2

Modifiable → Smoking, hypertension, hyperlipidaemia, obesity, diabetes.

Non-modifiable → Age, male gender, family history of CAD.

Question 3

What are the main classes of drugs used in ACS treatment?

Answer 3

Antiplatelet therapy → Prevents clot formation.
- Aspirin → Reduces platelet aggregation.
- P2Y12 inhibitors (clopidogrel, ticagrelor) → Further reduce clot formation.

Anticoagulants → Prevent thrombus progression.
- Heparin (LMWH or UFH) → Inhibits clotting factors.

Beta-blockers → Reduce myocardial oxygen demand by lowering heart rate and contractility.

Nitrates → Vasodilation to improve blood flow and reduce pain.

Statins → Lower LDL cholesterol and stabilize atherosclerotic plaques.

ACE inhibitors/ARBs → Reduce blood pressure and improve cardiac function.

Question 4

What are the key coronary interventions for ACS?

Answer 4

Percutaneous Coronary Intervention (PCI) → Stent placement to reopen blocked arteries.

Coronary Artery Bypass Grafting (CABG) → Used for multi-vessel disease or left main artery blockages.

Question 5

How do coronary interventions improve outcomes?

Answer 5

Restores blood flow, preventing myocardial damage.

Reduces mortality and recurrent events.

Improves quality of life by relieving symptoms.