Optimising Outcomes in Secondary Prevention of Coronary Heart Disease

Summary

Atherosclerosis is a diffuse disease of arteries. It cannot be definitively treated by procedures such as bypass surgery or angioplasty which correct only discrete anatomical lesions. The only definitive treatments for atherosclerosis are medical. In both men and women with coronary disease, treatment includes interventions such as smoking cessation, lipid management and blood pressure lowering, restriction of dietary calories, fat, and salt, increased physical activity, body weight reduction, β-adrenoceptor blocking drugs during the first 6 to 12 months or so after an infarct, and, in patients with congestive heart failure, the use of angiotensin-converting enzyme (ACE) inhibitors.

Specific guidelines describing the use of these interventions have recently been released by a consensus panel of the American Heart Association. These guidelines apply to both men and women with coronary disease, even though the preponderance of evidence on which they are based has been derived from intervention trials that included mostly men. The application of these guidelines cannot guarantee that coronary disease will not recur. It is unclear what, if any, additive effects they may have. Unlike anatomical interventions, however, they attack the underlying process of atherogenesis in whatever vascular bed it occurs. Failure to include these interventions in the care of patients with established coronary disease is a serious and potentially life-threatening omission.