[Secondary prevention of acute coronary syndrome]

The sudden conversion of a stable atherosclerotic plaque to an unstable and life-threatening atherothrombotic lesion which is known as plaque rupture is the potential mechanism for the development of acute coronary syndrome (ACS). Accordingly, secondary prevention of ACS could be achieved with the prevention of the plaque rupture and thrombus formation. Coronary angioplasty and coronary bypass surgery have a limited value in the long-term prevention of ACS. Coronary risk factor modification is certainly the important strategy for secondary prevention. The drug treatment with lipid lowering agents, especially 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG-CoA) reductase inhibitors, beta-adrenergic receptor blockers, antiplatelet agents and anticoagulants, have been proven to be effective for the secondary prevention of myocardial infarction. Estrogen for postmenopausal women has also been reported to be beneficial. However, calcium channel blockers except verapamil, nitrates and angiotensin converting enzyme (ACE) inhibitors are not recommended for the secondary prevention of ACS.