cardiovascular disorders
Drugs for Acute Coronary Syndromes
Other Drugs for Acute Coronary Syndromes
Angiotensin-converting enzyme (ACE) inhibitorsreduce mortality risk in patients with myocardial infarction, especially in those with anterior infarction, heart failure, or tachycardia. The greatest benefit occurs in the highest-risk patients early during convalescence. ACE inhibitors are given>24 hours after thrombolysis stabilization and, because of continued beneficial effect, may be prescribed long-term. Angiotensin IIreceptor blockers(ARBs) may be an effective alternative for patients who cannot tolerate ACE inhibitors (eg, because of cough). Currently, they are not first-line treatment after myocardial infarction. Contraindications include hypotension, kidney failure, bilateral renal artery stenosis, and known allergy. Statins(HMG-CoA reductase inhibitors) have long been used for prevention of coronary artery disease and ACS, but there is now increasing evidence that they also have short-term benefits, such as stabilizing plaque, reversing endothelial dysfunction, decreasing thrombogenicity, and reducing inflammation. Thus, all patients without contraindications (eg, statin-induced myopathy, liver dysfunction) to therapy should receive a statin at the maximally tolerated dose as early as possible following ACS regardless of their serum lipid levels. PCSK-9 inhibitors(evolocumab,alirocumab) are used for patients not at target LDL-C levels. They are used alone or in combination with other lipid-lowering therapies (eg, statins,ezetimibe) for the treatment of adults with primary hyperlipidemia (including familial hypercholesterolemia). 