Drugs in the Primary and Secondary Prevention of Coronary Artery Disease

The foundation for the prevention of coronary artery disease (CAD) is favorable modification of the risk factors of atherosclerosis. This is accomplished by lifestyle changes and, where necessary, pharmacological therapy. The latter comprises judicious use of evidence-based application of cardioprotective drugs. Multiple classes of these agents have been studied in controlled clinical trials which have provided convincing data for pharmacological primary and secondary prevention by reducing risk factors or modulating cardiac pathophysiology. The statin class of drugs is strongly advocated by the most recent prevention guidelines for the reduction of cardiovascular morbidity and mortality. However, in patients with elevated triglycerides and/or metabolic syndrome, evidence is unclear regarding the effects pharmacological therapy on prognosis. Beta-adrenergic blockers, inhibitors of the renin–angiotensin–aldosterone system (angiotensin-converting enzyme inhibitors [ACEI], angiotensin receptor blockers [ARBs], aldosterone inhibitors) improve survival and reduce recurrent MI in selected subgroups of myocardial infarction (MI) survivors. These classes of drugs also improve prognosis in selected patients with systolic cardiac dysfunction. The reduction of cardiovascular events has also been achieved in patients with hypertension by multiple drug classes, but beta-blockers are not recommended in the most recent hypertension guidelines because of absence of clear-cut evidence of benefit. Cessation of tobacco use is unequivocally advocated, but results of nondrug and drug methods are suboptimal. Influenza and pneumococcal vaccinations are recommended in patients with cardiac disease.