During my outpatient cardiology clinic experience, a saw a 50-something year old gentleman who was being referred to the clinic for regular cardiology follow up after a posterior STEMI in 2011. He had not seen a cardiologist for four years, and mentioned poor medication adherence. This was a reminder for me to review the pharmacologic and non-pharmacologic secondary prevention strategies in patients with coronary artery disease:
Pharmacologic
- Anticoagulation: aspirin 81mg tablet
- Blood pressure control (<140/90 or <130/80 for patients with diabetes or chronic kidney disease):
- ACEi/ARB
- Beta-blocker
- Statin: goal of <2 or 50% reduction in LDL cholesterol
Non-pharmacologic
- Smoking cessation
- Weight management: 10% weight loss is recommended for overweight/obese patients
- Exercise-based cardiac rehabilitation and/or physical activity: 150 minutes per week of moderate-vigorous exercise is recommended
- Diet: Portfolio and Mediterranean diets have proven benefits.
- Influenza immunization
Together, we came up with realistic goals for this patient to achieve by his next visit. I emphasized the importance of goal-setting and taking small but permanent steps towards these lifestyle changes in a way that best suited his life.
Resources:
- Secondary Prevention of Coronary Artery Disease. American Family Physician. https://www.aafp.org/afp/2010/0201/afp20100201p289.pdf
-IL-
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