Avoiding Repeat Cardiac Events: The ABCDESs of Tertiary Prevention

Multifactorial risk-factor modification-especially intensive ways to manage hyperlipidemia-may slow, halt, or even reverse the progression of coronary artery disease. The American Heart Association recently published comprehensive risk-reduction strategies in patients with coronary heart and vascular disease. These recommendations, endorsed by the American College of Cardiology, have been expanded and can be easily remembered as the ABCDESs of tertiary prevention: 'A': aspirin, alpha-tocopherol, and ACE inhibitors; 'B': beta-blockers, B-vitamins, and blood pressure control; 'C': cholesterol management; 'D': diabetes management and diet; 'E': exercise and estrogen therapy; and 'S': social support, smoking cessation, and stress management.