Update to Evidence-Based Secondary Prevention Strategies After Acute Coronary Syndrome
David H Fitchett1, Lawrence A Leiter1, Peter Lin2
1St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
CJC Open
|September 30, 2020
Summary
Optimizing secondary prevention after acute coronary syndrome (ACS) involves updated antiplatelet and anticoagulant strategies. New therapies like PCSK9 inhibitors and icosapent ethyl improve lipid management and address residual risk, while SGLT2 inhibitors and GLP-1 RAs benefit type 2 diabetes patients.
Area of Science:
- Cardiology
- Pharmacology
- Preventive Medicine
Background:
- Acute coronary syndrome (ACS) necessitates optimized secondary prevention to mitigate future cardiovascular events.
- Current evidence-based strategies require regular updates to incorporate new therapeutic advancements.
Purpose of the Study:
- To provide an updated synopsis of evidence-based secondary prevention strategies following ACS.
- To highlight recent clinical trial data influencing treatment choices for antiplatelet, anticoagulant, and lipid-lowering therapies.
Main Methods:
- Review of recent clinical trial data on antiplatelet and anticoagulant therapies.
- Analysis of new evidence on lipid-lowering agents, including proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors.
- Evaluation of studies on icosapent ethyl for residual risk management.
- Assessment of data on sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes.
Main Results:
- New data inform selection and duration of antiplatelet and anticoagulant treatments.
- Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors offer additional lipid-lowering benefits in high-risk patients on statins and ezetimibe.
- Icosapent ethyl addresses residual cardiovascular risk in statin-treated patients with elevated triglycerides.
- Sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists reduce cardiovascular events in type 2 diabetes, independent of glycemic control.
Conclusions:
- Secondary prevention strategies post-ACS are enhanced by new antiplatelet, anticoagulant, and lipid-lowering therapies.
- Targeting residual risk with agents like icosapent ethyl is crucial.
- Cardiovascular benefits of SGLT2 inhibitors and GLP-1 receptor agonists extend beyond glucose lowering in diabetic patients.
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