Secondary prevention of ischemic heart disease

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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.

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Non-pharmacological prevention[edit | edit source]

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),[1]
  • salt intake limit up to 6 g/day,[1]
  • adequate physical activity and overweight reduction to a BMI 18-25 kg/m2.[1]

Pharmacological prevention[edit | edit source]

Pharmacological prevention includes:

  • antiagregants: acetic acid 75–100 mg/day, clopidogrel 75 mg/day, ticagrelor 2x90 mg/day or prasugrel 10 mg/day;[1]
  • 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[edit | edit source]

Undoubtedly, secondary prevention also includes compensation:

  • dyslipidemia (LDL-C under 1,4 mmol/l);[1]
  • hypertension (blood pressure 120-130/70-80 mmHg);[1]
  • 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?).[2][3]

References[edit | edit source]

Related Articles[edit | edit source]

Reference[edit | edit source]

  1. ↑ a b c d e f Ošťádal P, Táborský M, Linhart A, et al. Stručný souhrn doporučení pro dlouhodobou péči o nemocné po infarktu myokardu. Cor Vasa 2019;61: e471–e480. dostupný také z <https://actavia.e-coretvasa.cz/pdfs/cor/2019/05/05.pdf>
  2. ↑ CÍFKOVÁ, Renata. Prevention of cardiovascular diseases in adulthood. Cor et Vasa [online]. 2005, vol. 47, no. 9, p. 4-13, Available from <http://www.kardio-cz.cz/resources/upload/data/49_Prevence_kardiovaskul%E1rn%EDch_onemocn%ECn%ED_v_dosp%ECl%E9m_v%ECku.pdf/>. ISSN 1803-7712. 
  3. ↑ WIDIMSKÝ, Petr. Diagnostika a léčba akutního infarktu myokardu s elevacemi ST. Cor et Vasa [online]. 2009, vol. 51, no. 10, p. 724-740, Available from <http://www.e-coretvasa.cz/casopis/data_view?id=2965>. ISSN 1803-7712. 

Bibliography[edit | edit source]

  • KLENER, P. Vnitřní lékařství. 3. edition. Galén, 2006. ISBN 80-7262-430-X.
  • ČEŠKA, Richard. Interna. 1. edition. Praha : Triton, 2010. pp. 367–368. ISBN 978-80-7387-423-0.
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