[Primary prevention of coronary heart disease : Evidence-based drug treatment]

Area of Science:

• Cardiology
• Preventive Medicine
• Pharmacology

Background:

• Coronary artery disease (CAD) is a leading global cause of death.
• Assessing individual cardiovascular risk is key to effective CAD prevention.
• Lifestyle modifications and targeted drug therapies can prevent CAD.

Purpose of the Study:

• To review the evidence for pharmacological interventions in the primary and secondary prevention of CAD.
• To identify effective treatments for major cardiovascular risk factors.
• To evaluate the benefit-risk ratio of various medications in CAD prevention.

Main Methods:

• Systematic review of documented evidence for CAD prevention strategies.
• Analysis of drug efficacy for hypertension, hypercholesterolemia, and type 2 diabetes.
• Evaluation of medications for primary and secondary prevention, including acetylsalicylic acid, beta blockers, and diabetes medications.

Main Results:

• ACE inhibitors, ARBs, calcium antagonists, statins, ezetimibe, PCSK-9 inhibitors, metformin, SGLT-2 inhibitors, and GLP-1 agonists show evidence for CAD prevention.
• Acetylsalicylic acid is recommended for secondary but not primary prevention in low-risk individuals.
• No evidence supports primary prevention with beta blockers, DPP-4 inhibitors, glitazones, sulfonylureas, insulin, obesity drugs, vitamin supplements, hormone preparations, or omega-3 fatty acids.

Conclusions:

• Targeted drug therapies for hypertension, hypercholesterolemia, and type 2 diabetes are crucial for CAD prevention.
• Risk stratification is essential to guide preventive strategies, particularly for acetylsalicylic acid use.
• Many commonly considered preventive agents lack evidence for efficacy in primary CAD prevention.