Fast Five Quiz: Secondary Prevention of Cardiovascular Disease

Yasmine S. Ali, MD


December 14, 2020

The preferred medication for secondary prevention of CVD, as noted in current guidelines, is an ARNI. ARNIs are an established therapy for patients with heart failure with reduced ejection fraction (HFrEF) on the basis of the results of PARADIGM-HF trial, which showed an association with reduced cardiovascular death or hospitalization for heart failure and provided evidence for treatment of HFrEF in various subsets of patients.

Aldosterone blockade can be used in post-MI patients who do not have significant renal dysfunction (creatinine level should be > 2.5 mg/dL in men and > 2.0 mg/dL in women) or hyperkalemia (potassium level should be < 5 mEq/L). In patients with chronic kidney disease and type 2 diabetes, treatment with the aldosterone-blocking agent finerenone was recently shown to lower the risks for chronic kidney disease progression and cardiovascular events compared with placebo.

Beta-blockers should be initiated and continued indefinitely in all patients who have had MI, acute coronary syndrome, or left ventricular dysfunction, with or without heart failure symptoms, unless contraindicated. For all other patients with coronary or other vascular disease or diabetes, consider chronic therapy unless contraindicated.

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