Pharmacotherapy STABLE coronary artery disease

1. Vasculoprotective therapy  used to reduce the RISK of future CV events

Vasculoprotective
therapy
1. Behavioural  Educate pt
modification  Diet (as followed by guidelines CPG 2018)
therapy  Physical activity / exercise (active lifestyle)  can lower lipid in the blood
 Smoking cessation
 Weight management
 Reduce serum cholesterol level
 Treat HTN
 Low dose of aspirin
 Postmenopausal oestrogen replacement

2. Risk factor 1. Statin

modification  In pt stable CAD, the level of LDL-C is lower (=improve prognosis-possible outcomes) and thus has better outcome (result)
 In pt with higher LDL-C baseline = 2.6 mmol/L  statin helps to intensively reduce LDL-C and thus reduce the CV mortality
 Before PCI, reloading with high intensity of statin MAY BE CONSIDERED since statin helps to reduce peri-procedural MI
either in statin-naive or chronic statin therapy pt
2. ACEI
 Pt post-MI + HFrEF + LVEF ≤ 40%  secondary prevention
 Stable CAD + reduced LV function  should take the following drugs to improve outcome:
 ACEI/ARB
 BB
 MRA (spirolactone and eplerenone)
 AR-NI (entresto)

 In patients with stable CAD + without MI & without LV damage (taking ACEI  ramipril 8 mg & perindopril 10 mg in
respective study)  20 % of them reduce in CV death, MI and stroke
 Recently, ACEI / ARB are proved not to reduce CV event. Therefore, stable CAD pt + without HTN / normal LV function 
not recommended to take ACEI (so group post MI je yg blh ambik ACEI point mula2)