Secondary prevention therapy in patients with coronary artery disease

Recent therapeutic advances have reduced cardiac morbidity and mortality in patients with clinically documented coronary artery disease (CAD). This secondary prevention approach (as opposed to the primary prevention approach to avert the emergence of clinical cardiac disease in healthy individuals) encompasses three broad categories: coronary risk factor modification (eg, control of hypercholesterolemia, hypertension, body weight, and smoking through lifestyle changes and drug therapy), use of cardioprotective drugs (eg, aspirin, beta blockers, ACE inhibitors), and myocardial revascularization. Until recently, therapy has focused on revascularization, despite its high cost. However, recent studies showing the efficacy of risk factor modification and cardioprotective drugs, combined with economic concerns, have increased the emphasis on these modalities for secondary prevention of coronary events.