Pharmacological Treatment in Patients with Coronary Heart Disease

 Low-dose aspirin.

From various studies have shown that aspirin is still the main drug for the prevention of thrombosis. Meta-analysis showed that a dose of 75-150 mg have similar effectiveness when compared with larger doses. Recommended for all patients were given aspirin except when contraindicated found. In addition aspirin is also recommended given the long term, but keep in mind the side effects of gastrointestinal irritation, bleeding and allergies. Cardioaspirin provide a more minimal side effects compared with other aspirin.

   Clopidogrel dan Ticlopidine Thienopyridine

an ADP antagonist and inhibits platelet aggregation. Clopidogrel is more indicated in patients with aspirin resistance or intelorensi against. AHA / ACC guidelines include a combination of aspirin and clopidogrel should be given to patients with stent implantation, more than 1 month for bare metal stent, 3 months for sirolimus eluting stents, and over 6 months for paclitaxel-eluting stents.

  Cholesterol-lowering drugs

Treatment with statins are used to reduce the risks to both primary prevention and secondary prevention. Various studies have shown that statins can reduce complications by 39% (Heart Protection Study), Ascott-LLA atorvastatin for primary prevention of coronary heart disease in post-hypertension. Than as a cholesterol-lowering statins also have other mechanisms (pleiotropic effect) that can act as an anti-inflammatory, anti-thrombotic and others. Giving atorvastasin 40 mg for one week can reduce the myocardial damage caused by the action. The target reduction in LDL cholesterol is <100 mg / dl and in patients at high risk. Patients with coronary heart disease is recommended lowering LDL cholesterol <70 mg / dl.

  ACE-Inhibitor/ARB

The role of ACE-I as a cardio protection for secondary prevention in patients with coronary heart disease has been demonstrated from various studies ai, HOPE study, EUROPE study and others. If intolerance to ACE-I can be replaced with ARB.

  Nitrate

Nitrate is generally recommended, because nitrate has venodilator effect, so that myocardial preload and left ventricular end volume decreases and thus the amount of myocardial oxygen consumption also decreases. Nitrates also dilate blood vessels to be normal and atherosclerotic experience. Raising the collateral blood flow and inhibits platelet aggregation. When an attack of angina does not respond to short-term nitrate, then be aware of the existence of myocardial infarction. Side effects of this drug are headache and flushing.