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[Secondary prevention in patients after a myocardial infarct]
1III. interná klinika LFUK, Bratislava.
Insights
Secondary prevention is crucial after myocardial infarction (MI) to reduce cardiovascular death risk. Optimal therapy, risk factor modification, and targeted cholesterol management (LDL, HDL) are key to improving outcomes for heart attack survivors.
Area of Science:
- Cardiology
- Preventive Medicine
- Biochemistry
Context:
- Ischaemic heart disease significantly elevates cardiovascular mortality risk (over 80%).
- Myocardial infarction (MI) survivors face a 5-7 fold increased risk of new coronary events.
- Urgent secondary prevention strategies are vital to mitigate this heightened risk.
Purpose:
- To outline the critical importance and components of secondary prevention following myocardial infarction.
- To emphasize the need for early patient stratification and risk factor modification.
- To define target lipid levels for secondary prevention in post-MI patients.
Summary:
- Optimal acute phase therapy, including risk stratification for intervention versus conservative management, is foundational for secondary prevention.
- Modifying classical risk factors such as hypertension, smoking, and hypercholesterolaemia benefits all post-MI patients.
- Targeting LDL cholesterol below 2.6 mmol/l and HDL cholesterol above 1.0 mmol/l is essential, recognizing the detrimental role of oxidized LDL and oxidative stress.
Impact:
- Effective secondary prevention strategies can significantly reduce the high mortality and morbidity associated with ischaemic heart disease and MI.
- Early identification of high-risk patients allows for timely interventions, improving long-term prognosis.
- Addressing oxidative stress and metabolic syndrome components is crucial for comprehensive cardiovascular risk reduction.
Abstract:
The confirmation of ischaemic disease of the heart increases the probability of death due to cardiovascular causes to more than 80%. The overcoming of myocardial infarction increases, according to the past AHA data, the risk of the origin of a new coronary episode 5 or 7-fold. The necessity of decreasing this risk in the frame of secondary prevention is therefore very urgent. The first assumption of success in secondary prevention resides in optimal therapy in the acute phase of myocardial infarction. The thrombolytic therapy is accompanied by risks of re-perfusion lesion implying from the increased production of free oxygen radicals, activation of leukocytes, intracellular calcium overload at a current deficit in potassium and magnesium, the defects of coronary microcirculation, increased sympathetic activities, general disturbances of energetic reserves in myocardium. Very significant is an early stratification of patients after MI to those indicated to intervention/in case that the mass of ischaemic myocardium exceeds 20%, or if EF is below 40%, and to patients who regarding the low risk are manageable by conservative procedure. Both groups profit from the modification of classical risk factors (hypertension, smoking, hypercholesterolaemia). The values of cholesterol measured within the acute phase of myocardial infarction are not indicative, very often they are low. Finally, also in the later period with so-called adequate values of the total cholesterol, the patient after overcoming IM is increasingly under threat. The aim of secondary prevention is to reduce the chief pathogen, namely LDL cholesterol below 2.6 mmol/l, the level of HDL cholesterol on the opposite should be above 1.0 mmol/l. It is necessary to re-emphasize that the bioactive capacity is borne but by the oxidated form of LDL. Oxidative stress has a direct negative effect on vascular endothelium, and haemocoagulation potential, it participates in the metabolic X syndrome (insulin resistance, hyperinsulinaemia, defects in glucose tolerance, hypertriglyceridaemia, hypertension). (Ref. 41.)