Geno J. Merli, MD; Howard H. Weitz, MD
Disclosures: Geno J. Merli, MD, reports the following: Research grants/contracts: Bristol-Myers Squibb, Bayer, sanofi-aventis; Consultancies: Bristol-Myers Squibb, Bayer, sanofi-aventis. Howard H. Weitz, MD, reports that he has no financial relationships or interests to disclose.
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Yehia Y. Mishriki, MD, FACP
Lehigh Valley Health Network
January 11, 2015
"Re-balancing" a patient's drug portfolio five years after MI
Perhaps obvious but worth mentioning, the beta blocker should be slowly weaned off over the course of at least 2 weeks. In addition, whether one subscribes to the newer hyperlipidemia guidelines or still goes by the "treat to target" approach, one needs to know what type and what dose of the statin the patient is taking. He should be taking a high dose potent statin (newer guidelines) or achieve an LDL of 70 mg/dl or less (treat to target) which would be ideal (rather than the 90 mg/dl which is acceptable).
Bangladesh Institute of Family Medicine and Research
August 15, 2015
A patient should get lifelong statin for secondary cardiovascular event prevention
Excellent. This patient as per his present condition should continue with low dose aspirin daily (81-162mg) and a statin for whole life. Statin dose may be selected according to ASCVD risk as described by ACC/AHA ATP-IV guideline.I think it is already time to stop “Treat to Target” approach for statin use. If we use “Treat to Target”, question should arise, should I stop statin once target is achieved?Specifically for this patient, statin should be continued indefinitely because he is a patient with established ASCVD, one of the four groups of patients who should get statin as described by ATP-IV guideline.
Merli GJ, Weitz HH. The Consult Guys - Balancing the Medication Portfolio 5 Years After a Heart Attack. Ann Intern Med. ;161:CG12. doi: 10.7326/G14-3012
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Published: Ann Intern Med. 2014;161(12):CG12.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine.
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