secondary prevention of CAD Flashcards
when is secondary prevention needed?
patients with confirmed CAD or vascular equiv
what is goal of secondary prevention
prevent plaque rupture and progression
secondary prevention with pharm
1) anti-platelet (P2y112 inhibitor or theienopyridines/thromboxane synthetase inhib) = block activ/adhesion from PLT
2) beta blocker
3) RAAS inhibitors
what drug paired with aspirin reduces MI and stent thrombosis
thienopyridines
thienopyridines + aspirin reduce ___
MI and stent thrombosis
guidelines for class 1 antiplatelet
for all CAD patients
ASA 75-162 mg
guidelines for class 1 antiplatelet
for all ACS or PCI
Thienopyridines + aspirin
1 yr after event
guidelines for class 1 antiplatelet
for post bypass surgery
asa 100-325 mg
for at least 1 yr
guidelines for class 1 antiplatelet
for post stroke
ASA alone
Clopidogrel alone
or combined apsirin + dipyridamole daily
guidelines for class 1 antiplatelet
for symptomatic PAD patients
asa alone
clopidogrel alone
guidelines for class 1 antiplatelet
if requiring warfarin for something else
low dose asa and monitor BLEEDING
effects of beta blockers
1) decr HR
2) decr contractility
3) decr conduction velocity
4) decr systemic BP
class 1 beta blocker guideline
when to use
ALL PATIENT WITH
1) LVSD <40%
2) HF SX IN LAST 3 YRS
3) MI/ACS in last 3 yrs
class IIa beta blocker guideline
when to use
1) LVSD <40% even without HF sx
2) hx of MI/ACS
effects of RAAS blockers
1) vasodilation
2) natriuresis
3) decr sympathetic
4) decr cardiac remodeling
especially LVSD and diabetics
class 1 RAAS inhibitor guideline
ACEI
LVSD <40%
DM
HTN
CKD
class 1 RAAS inhibitor guideline
ARB
ACEI intolerant
class 1 RAAS inhibitor guideline
aldosterone inhibitor
LVSD <40% after MI receiving therapeutic beta blocker and ACEI/ARB + HF or diabetes
AVOID WITH RENAL FAILURE OR HYPERKALEMIA
HOW TO CONTROL blood pressure
1) decr saturated fat/sodium <2.4 g/day
2) RAAS inhibitor (ACEI/ARB)
3) beta blocker
4) diuretic
5) calcium channel blocker
6) direct vasodilator
class 1 blood pressure guideline
< 60 y/o
< 140/90
class 1 blood pressure guideline
> 60 y/o
< 150/90
are non-statin lipid treatments effective?
no
bile-acid binding agents
niacin
fibrates
does decreasing BP below 140/90 show benefit?
no as long as < 140/90
a
a
class 1 lipid guideline
when to use
ALL CAD
class 1 lipid guideline
drugs for high dose statin
atorvastatin 80mg
rosuvastatin 20-40 mg
class 1 lipid guideline
drugs for mod dose
atorvastatin 10-20 mg
rosuvastatin 5-10 mg
pravastatin 40-80 mg
simvastatin 20-40 mg
which patients are not proven for use with statin
NYHA Class 3-4
Hemodialysis
Myopathy/myalgias
new onset DM, rhabdo
___ control DOES NOT REDUCE MI AND MAY CAUSE HARM
glycemic control
glycemic control does not ___
does not reduce MI outcome
may cause harm
class 1 diabetes guideline
lifestyle mod with PCP
class IIa diabetes guideline
metformin first line
class IIb diabetes guideline
HbA1c <7%
depression treatment in CV events
improves depression symptom
NOT CARDIAC EVENTS
class IIa depression guideline
just assess depression
class IIb depression guideline
treat depression to improve mental health not outcome
how does smoking affect atherosclerosis
1) oxid LDL
2) inflamm
3) decr HDL
4) endothelial dysfunction, decr NO
class 1 smoking guideline
STOP SMOKING
no exposure to secondhand smoke
obesity is defined by both ___
bmi
waist size
weight loss strategies
diet component
caloric restriction
nutrition counseling
physical activity
MACRONUTRIENTS LESS IMPORTANT
weight loss strategies
meds
orilstat
weight loss strategy
bariatric surgery
bmi >40 or >35 with co-morbidities
class 1 weight control guideline
goal bmi = 18.5-24.9
waist <35 women
lose 5-10% of body weight initially
class 1 physical activity guideline
moderate to high intensity 30-60 min per day 5 day per week
