Once a patient has been identified as having coronary artery disease (perhaps by suffering a myocardial infarction), then every effort must be made to slow or halt the progression of the underlying disease process. Doing so involves using each of two major strategies: the pharmacological strategy, and the non-pharmacological strategy.
The pharmacological strategy uses drugs to either slow the progression of the coronary artery disease, or to prevent the sudden occlusion of a diseased coronary artery (by preventing the acute clotting phenomenon that causes the occlusion). The following drugs are important in this regard:
Aspirin: Aspirin reduces the “stickiness” of platelets, and thus reduces the chances of developing a blood clot at the site of an atherosclerotic plaque. (Click here to review the blood clotting mechanism, and how it causes heart attacks). Aspirin has been shown to significantly reduce vascular mortality in patients with known coronary artery disease, and without question should be used in every heart attack survivor, unless there are strong reasons not to.
Statins: Several randomized clinical trials now show that prescribing statin drugs after a heart attack in patients with elevated LDL cholesterol levels will significantly reduce the risk of recurrent myocardial infarction, and will significantly reduce mortality. More recently, studies have shown that statins reduce mortality even if LDL cholesterol is not especially high. In fact, patients with established coronary artery disease ought to have their LDL cholesterol levels reduced to < 70 mf/dL. (Click here for a review of the latest recommendations on LDL cholesterol).
The non-pharmacological strategy for slowing the progression of coronary artery disease involves reducing any risk factors the patient may have. These include weight loss, beginning a low fat – low cholesterol – low saturated fat diet, smoking cessation, excellent control of diabetes and hypertension if present, and regular aerobic exercise. All patients should receive extensive training on how to modify these risk factors after a heart attack. Unfortunately, the push to get people out of the hospital quickly after a heart attack nearly precludes adequate instruction on risk-factor modification.
