Page 44 - GALENIKA MEDICAL JOURNAL

SECONDARY PREVENTION OF

CARDIOVASCULAR DISEASES: FROM INITIAL

FINDINGS TO THE IMPLEMENTATION OF

INDIVIDUAL THERAPEUTIC MEASURES

Ivana Burazor 1, 2 only typically but also atypically, with varying levels of risk
1 Faculty of Medicine, University of Belgrade, Serbia and complications, often with unpredictable course and
4-6
2 Institute for Cardiovascular Diseases "Dedinje", Belgrade, Serbia prognosis, including sudden cardiac death .
Acute Myocardial Infarction (AMI) is now promptly reco-
Corresponding author: gnized and effectively treated, thanks to the use of sophisti-

Klin. asist. dr sci med Ivana Burazor cated diagnostic methods and laboratory tests, especially
with the implementation of (primary) percutaneous coro-
Institut za kardiovaskularne bolesti „Dedinje“, Beograd, Srbija nary interventions, significantly reducing mortality. Howe-
ivana.burazor@gmail.com ver, despite this, these patients are at high risk for recurrent
major adverse cardiovascular events (MACE) after the index
event .
7, 8
Abstract
Basic principles of secondary prevention
Patients who have survived an acute myocardial
infarction, as well as those with atherosclerotic The European Society of Cardiology - European Associa-
8
cardiovascular disease, established or unequivocally tion of Preventive Cardiology in its latest guidelines iden-
confirmed by imaging techniques, represent a very tifies a high-risk group of patients. This group includes all
patients with established atherosclerotic disease - acute co-
high-risk group. This group of patients requires more ronary syndrome, coronary revascularization, other arterial
aggressive treatment of risk factors, regular controls, revascularization procedures, cerebrovascular accident or
and monitoring of the effect of therapy. The article transient ischemic attack (TIA), aortic aneurysm, and perip-
aimed to point out the historical importance of risk heral arterial disease. Additionally, the group includes pa-
factors and modern models for assessing residual risk tients with unequivocally confirmed atherosclerosis (signifi-
by reviewing the literature. Recognizing the residual risk cant plaque on coronary angiography or carotid ultrasound
8
provides orientation and motivation for more aggressive examination). The guidelines provide further defined the-
implementation of secondary preventive therapy on rapeutic measures and goals in secondary prevention.
Emphasis is placed on the necessity of further identifying
an individual level in daily work with patients and the patients with residual cardiovascular risk to implement indi-
possibility of reaching the target values recommended by vidual strategies in secondary prevention.
European guidelines.
The basic principles of secondary prevention are: promo-
Keywords: established atherosclerotic cardiovascular ting healthy lifestyle habits (physical activity, healthy diet,
disease, secondary prevention, residual risk and smoking cessation), achieving recommended target va-
lues for blood pressure and LDL cholesterol, and using an-
tiplatelet therapy. After implementing preventive measures
(defined as the first step ), individual assessment of residual
8
Introduction risk, life risk, presence of comorbidities, and assessment of
Cardiovascular diseases, especially coronary heart di- the benefits of the applied therapy is recommended (in the
8
sease, are the leading cause of death both locally and glo- second step ). Patient education is necessary. The decision
bally, and they are the most common reason for emergency is made jointly, respecting personal preferences (Scheme 1).
hospitalization and urgent treatment to prevent fatal out- This group of patients certainly requires more aggres-
comes .
1-3
sive management of risk factors, regular monitoring and
In clinical terms, coronary artery disease is not a homo- follow-up of treatment effects, as well as calculating indivi-
geneous clinical entity. It encompasses a spectrum of acute dual, or personalized residual risk to further optimize thera-
and chronic coronary syndromes and a range of subtypes py and reduce risk.
of clinical presentations. These presentations can occur not

42 DOI: 10.5937/Galmed2409049B