SECONDARY PREVENTION IN STABLE ANGINA

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Abstract

Risk stratification of coronary events in 5 years performed at the basis of available non invasive stress tests helps in the choice of management tactics. Revascularization has a significant prognostic impact not only for high risk patients. As in patients with ischemic heart disease (IHD) heartbeat rate more than 70 per minute is an independent predictor of myocardial infarction development, high heartbeat rate is one of the therapeutic targets in secondary prevention. Blood pressure control in patients with arterial hypertension and IHD is also important as 25% of population risk of myocardial infarction development is determined by arterial hypertension. The advantage of low (75-150 mg) and medium (160-325 mg) doses of acetylsalicylic acid (ASA) in atherothrombotic complications prevention in patients with stable IHD has been proven. Enteric coating prolongs ASA release and absorption. Unlike simple ASA, only after repeated daily use of gastro-resistant tablets platelet cyclooxygenase acetylation is cumulated and results in sufficient decrease of its activity at the 6th day that results in significant inhibition of platelet function. Dyslipidemia correction and lipid profile parameters maintenance at target levels throughout lifetime significantly decrease cardiovascular mortality as a result of secondary prevention in all age groups both in males and females. If the target level of low density lipoproteins is not reached on statins use they can be combined with ezetimibe that inhibits cholesterol absorption in intestine. In patients with persisting high levels of low density lipoproteins despite adherence to a diet and use of as high as possible statins doses, use of medications from the group of PCSK9 inhibitors is indicated. The use of monoclonal antibodies to interleukin-1 р (canakinumab) in patients with stable IHD with C-reactive protein level more than 2 mg/l showed the importance of inflammation in development of atherosclerosis and its complications. Although suppression of body ability to develop inflammatory processes is highly effective in cardiovascuar events prevention if systemic inflammation is present, their use is unlikely to become routine in all patients groups as treatment with canakinumab was associated with increase of fatal infectious complications. It is recommended to patients with IHD to perform seasonal flu vaccination. For those who seek medical advice in first 2 days after flu symptoms development it is reasonable to use antiviral medications. Chronic inflammation as a key element of atherosclerosis pathogenesis can be associated not only with infectious and immune but also with metabolic factors that requires improvement of other organs and systems health, change of behavior and lifestyle.

About the authors

Andrei A. Kirichenko

Russian Medical Academy of Continuous Professional Education

Email: andrey.apollonovich@yandex.ru
д-р мед. наук, проф., зав каф. терапии

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