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MYOCARDIAL INFARCTION
UNSTABLE ANGINA
PRIMARY PREVENTION aimed at either delaying atheroma
formation or causing regression of established lesions in persons
who have never suffered a serious complication of
atherosclerotic coronary artery disease
Assess
Identify smokers willing to quit
Fortunately, just eating more fish reduces the risk for coronary disease,
stroke, and all-cause mortality
may improve insulin action
and glycemic control,
Diet high in particularly in patients with
carbohydrate (>50%) mild hyperglycemia
reduction of alcohol
consumption is associated
with a reduction of blood
pressure
reduction in plasma
triglycerides and has beneficial
reduction in blood
low-density effects on glucose
pressure, both in improvement in
lipoprotein metabolism and the
association with or atherogenic lipid
cholesterol and sensitivity of
independently of profiles
elevation of high- skeletal muscle to
weight loss
density lipoprotein insulin
cholesterol
It is not necessary for the obese patient to increase maximal oxygen uptake
by strenuous exercise to derive benefit from exercise: metabolic evidence of
improvement in fitness is achieved with less vigorous exercise such as walking
increased distances and swimming
Exercise
lowers BP through multiple
mechanisms, including the following:
Lower sympathetic nerve traffic accompanied
by potentiation of the baroreceptor reflex
Reduced arterial stiffness and increased total
systemic arterial compliance
Increased release of endothelium-derived
nitric oxide that may be related to lower
plasma cholesterol
Increased insulin sensitivity
LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle
Changes (TLC) in Different Risk Categories
The first maneuver to achieve
the LDL goal involves
therapeutic lifestyle changes
(TLC), including specific diet
and exercise recommendations
established by the guidelines
*The rationale for these goals is that the risk of CHD is similar
to that in patients without diabetes who have had a prior MI.
Advances in secondary prevention
have resulted in increasingly
effective measures to reduce
recurrent MI and cardiovascular
death
Secondary prevention should be
conscientiously applied after acute
MI
A fasting lipid profile is
recommended on admission, and
lipid-lowering therapy, typically with
a statin, is begun in the hospital,
generally with an LDL cholesterol
goal of less than 70 mg/dL .
Continued smoking doubles the subsequent
mortality risk after acute MI, and smoking
cessation reduces the risk of reinfarction and
death within 1 year.
An individualized smoking cessation plan
should be formulated, including pharmacologic
aids (nicotine gum and patches, bupropion)
Antiplatelet therapy should consist of
aspirin, given on a long-term basis to all
patients without contraindications
(maintenance dose, 75 to 162 mg/day).