Acute coronary syndromes secondary prevention

Atorvastatin, simvastatin, rosuvastatin Inhibit HMG-CoA reductase Reduce cholesterol synthesis and up-regulate low-density lipoprotein (LDL) receptors on hepatocytes modest reduction in triglycerides Atherosclerotic vascular disease (primary and secondary prevention) t acute coronary syndromes Oral duration 12-24 h Toxicity Myopathy, hepatic dysfunction Interactions CYP-dependent metabolism (3A4, 2C9) interacts with CYP inhibitors... 

Secondary prevention. In a meta-analysis of randomised, controlled studies in patients following myocardial infarction or acute coronary syndrome, intensive warfarin (INR greater than 2) plus aspirin 80 to 325 mg daily was associated with 2.5-fold increased risk of major bleeding, when compared with aspirin alone, although the actual incidence was low (1.5% versus 0.6%). This analysis excluded studies of coronary stenting, see (b) above. In another similar meta-analysis, combined use of aspirin and warfarin (INR 2 to 3) was associated with a 2.3 odds ratio of a major bleed, when compared with aspirin alone.The number needed to treat to cause one major bleed was 100. This compared with a number needed to treat to avoid one major adverse event (death, myocardial infarction or stroke) of 33. 

Cheng K, Ingram N, Keenan J, Choudhury RP (2015) Evidence of poor adherence to secondary prevention after acute coronary syndromes possible remedies through the application of new... 

Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X (2008) Interventions for enhancing medication adherence. Cochrtme Database Syst Rev 2 CD000011 Ho PM, Lambert-Kerzner A, Carey EP et ai (2014) Multifaceted intervention to improve medication adherence and secondary prevention measures after acute coronary syndrome hospital discharge a randomized clinical tritil. JAMA Intern Med 174 186-193 Ho SC, Chong HY, Chaiyakunapruk N, Tangiisuran B, Jacob SA (2016) Clinical and economic impact of non-adherence to antidepressants in major depressive disorder a systematic review. J Affect Disord 193 1-10... 

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