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Feature Article

Secondary prevention of coronary heart disease

Ian Hamilton-Craig

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Abstract

Risk factors must be assessed and treatment targets met to prevent patients with established coronary heart disease having further cardiovascular episodes.

Key Points

  • Patients with coronary heart disease (CHD) have a more than 20% risk of having a further cardiovascular disease event within five years.
  • Patients with CHD should be screened for dyslipidaemia at six to eight weeks after an MI and for diabetes at least eight weeks after an MI.
  • Duplex ultrasound can be used to check for carotid, abdominal aortic and femoropopliteal atherosclerosis in patients with CHD.
  • It is standard to give the SAAB regimen (a statin, aspirin, an angiotensin-converting enzyme inhibitor and a beta blocker) to patients who have had an acute coronary syndrome.
  • Blood pressure targets in patients with CHD are determined by the presence of diabetes, renal dysfunction and proteinuria.
  • Assessment and treatment of depression and social isolation are important in the overall management of patients with CHD.

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