| Pharmacologic therapies after myocardial infarction. | |
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MedLine Citation:
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PMID: 8900339 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Despite the availability and use of effective methods for limiting infarct size with thrombolytic agents and primary angioplasty, patients experiencing a myocardial infarction (MI) are at increased risk for a second cardiac event in the post-MI period (e.g., reinfarction, heart failure, and sudden death). For this reason, postinfarction risk management is crucial. An extensive data base has firmly established the efficacy of beta blockers in reducing cardiovascular risk following acute MI. The full advantages of angiotensin-converting enzyme (ACE) inhibitors have only recently begun to emerge as the result of a growing understanding of the mechanisms of adverse outcomes following MI. The importance of lipid-lowering agents, in particular the "statins," should be considered in all post-MI patients, especially since recent studies have conclusively shown improved survival and reduced rates of MI and coronary artery bypass surgery in this population with this therapy. Aspirin is now considered a standard part of the early management of the acute infarct patient as well as for secondary prevention in post-MI patients. At present, chronic anticoagulation with warfarin should be reserved for selected patients. The nondihydropyridine calcium antagonists diltiazem and verapamil can be considered for post-MI use only in patients in whom beta blockers are contraindicated and who have preserved systolic function and/or those without clinical heart failure. In contrast, the dihydropyridine calcium antagonists, particularly nifedipine, have no role in secondary prevention. Although long-term benefits are minimal, nitrates continue to be useful in post-MI patients with residual ischemia (angina or silent ischemia), heart failure (systolic or diastolic), or postinfarction hypertension. Antiarrhythmic agents, except amiodarone, are relatively contraindicated in post-MI patients. Recent data show that vitamin E reduces the rate of nonfatal MI. Its role in cardiovascular death and overall mortality remains to be clarified. Despite their demonstrated value, agents used in secondary prevention generally appear to be underutilized. In addition, when pharmacologic therapies are administered for secondary prevention, they are often prescribed at lower doses than those tested and proved in trials. A greater appreciation for the efficacy and safety profiles of these agents could lead to more widespread use and more pronounced reductions in morbidity and mortality among post-MI patients. |
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Authors:
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E Rapaport; M Gheorghiade |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: The American journal of medicine Volume: 101 ISSN: 0002-9343 ISO Abbreviation: Am. J. Med. Publication Date: 1996 Oct |
Date Detail:
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Created Date: 1996-12-05 Completed Date: 1996-12-05 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0267200 Medline TA: Am J Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 4A61S-69S; discussion 4A69S-70S Citation Subset: AIM; IM |
Affiliation:
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San Francisco General Hospital, California 19440-0846, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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therapeutic use Angiotensin-Converting Enzyme Inhibitors / therapeutic use Anti-Arrhythmia Agents / therapeutic use Anticoagulants / therapeutic use Antilipemic Agents / therapeutic use Antioxidants / therapeutic use Aspirin / therapeutic use Calcium Channel Blockers / therapeutic use Clinical Trials as Topic Humans Myocardial Infarction / drug therapy*, mortality Nitrates / therapeutic use Platelet Aggregation Inhibitors / therapeutic use Recurrence Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Anti-Arrhythmia Agents; 0/Anticoagulants; 0/Antilipemic Agents; 0/Antioxidants; 0/Calcium Channel Blockers; 0/Nitrates; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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