Atherosclerotic CVD

Secondary prevention of further events after a STEMI, NSTEMI, Acute cerebrovascular event, or the diagnosis of stable angina/peripheral artery disease: statin, aspirin, ACE inhibitor, ± beta-blocker.

Statin: Manage as per guidelines on lipid modification, irrespective of baseline lipid level. Additional drugs may be needed - eg ezetimibe, fenofibrate. The 2025 NHFA/CSANZ ACS guideline sets a numeric secondary-prevention target of LDL-C <1.4 mmol/L and ≥50% reduction from baseline.

Aspirin: 100–150mg daily. Clopidogrel 75mg daily if intolerant to aspirin. If a patient needs anticoagulation (eg due to AF), then cease anti-platelet unless recent re-vascularisation, in which case d/w cardiology.

ACE inhibitor: Prevent AMI, stroke and death in pts with astherosclerotic CVD — titrate to the maximum tolerated daily dose. Use ARBs if pt does not tolerate ACEi (cough, angioedema).

Beta-blocker: started immediately after ACS. However routine longer use no longer recommended in pts with Successful revascularisation, preserved LV function, and no angina — the 2024 REDUCE-AMI trial supports stopping at 12 months in these patients. If pts have LVEF <40% use Carvedilol, Bisoprolol or Nebivolol. Not recommended for peripheral vascular disease.

Lifestyle: smoking cessation (36% reduction in all-cause mortality). Also advise on healthy diet, regular exercise, weight management, reduced alcohol intake. Cardiac Rehabilitation improves outcomes (mortality and morbidity) and QoL following cardiovascular event.