[Secondary prevention after myocardial infarction; rôle of platelet antiaggregants and hypolipemic agents].
The goals of secondary prevention after myocardial infarction are to avoid the complications of infarction itself, to prevent reinfarction, to detect and treat ischaemic episodes and to slow the progression of atherosclerosis. Antiplatelet therapy, especially with aspirin, has a clearcut beneficial effect decreasing cardiovascular mortality and of non-fatal reinfarction. A metaanalysis of ten trials has shown a 25% decrease in vascular events in the long-term, irrespective of age, gender, blood pressure blood glucose level, and dosage whether low (75 to 160 mg) or moderate (160 to 325 mg/day). Apart from the irreversible inhibition of cyclooxygenase, a beneficial effect on remodelling may be observed. Lipid lowering therapy has made significant advances since the introduction of the statimes. Compared with fibrates, statines have the advantage of reducing total mortality in addition to coronary mortality, whereas the fibrates, though reducing the latter, have been reported to increase total mortality and non-coronary mortality, but in a non-significant manner. Fibrates remain the drugs of choice for the treatment of pure hypertriglyceridaemia. The mechanisms of action of the statine are diverse: effects on endothelium-dependent relaxation, haemostasis, stabilisation of the atheromatous plaque and prevention of its rupture. The cost/effectiveness ratio of aspirin and statines is very high, the latter being much more cost-effective than, for example, the treatment of mild hypertension.
Aumont
M C
MC
Service de cardilogie A, hôpital Bichat/Claude-Bernard, Paris.
Seknadji
P
P
D000924:Anticholesteremic Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D003327:Coronary Disease / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D015248:Gemfibrozil / Q000627:therapeutic use; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008148:Lovastatin / Q000031:analogs & derivatives / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D019821:Simvastatin
D000924:Anticholesteremic Agents; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors; D008148:Lovastatin; D019821:Simvastatin; D015248:Gemfibrozil; D001241:Aspirin
Prévention secondaire de l'infarctus du myocarde; place des antiagrégants plaquettaires et des hypolipémiants.