Secondary prevention of ischemic heart disease

Secondary prevention is a set of measures that reduce the risk of recurrence of ischemic heart disease. Every patient should be monitored by a cardiologist or internist after he suffered MI, who should actively seek out and reduce cardiovascular risk factors.

Non-pharmacological prevention
Non-pharmacological prevention includes:


 * adjustment of eating habits (reduction of animal fat up to 30% of energy intake, increase of fruit and vegetables),
 * STOP smoking,
 * reduction of alcohol consumption (we tolerate up to 30g of pure alcohol per day for a healthy man, for women a dose of approximately 12 g/day),
 * salt intake limit up to 6 g/day,
 * adequate physical activity and overweight reduction to a BMI 18-25 kg/m2.

Pharmacological prevention
Pharmacological prevention includes:
 * antiagregants: acetic acid 75–100 mg/day, clopidogrel 75 mg/day, ticagrelor 2x90 mg/day or prasugrel 10 mg/day;
 * anticoagulants: in patients after MI with concomitant atrial fibrillation, left ventricular aneurysm, wall thrombus, or a history of pulmonary embolism; the goal is to achieve INR = 2,0–2,5;
 * statins;
 * cardioselective β-blocators (in all patients after STEMI, in patients with concomitant LV failure - carvedilol);
 * ACEI (in patients after AI with EF below 40% or with manifestations of heart failure);
 * Nitrates/calcium channel blockers (in patients after infarction with angina pectoris).

Mnemonic aid: BASIC (β-blocator, ASA, Statin, ACEI, Clopidogrel).

Compensation for associated diseases
Undoubtedly, secondary prevention also includes compensation:


 * dyslipidemia (LDL-C under 1,4 mmol/l);
 * hypertension (blood pressure [tel:120-130/70-80 120-130/70-80] mmHg);
 * diabetes (in diabetics II. type – fasting blood glucose below 6.0 mmol/l and blood glucose 2 hours after a meal below 7,5 mmol/l; HbA1C ≤ 6,5%);
 * coagulopathy (factor V or prothrombin gene mutations?).

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