Cad medications
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Cardiovascular Medications for Coronary Artery Disease (CAD)
Importance of Medication Adherence in CAD
Adherence to cardiovascular medications is crucial for the secondary prevention of coronary artery disease (CAD). Studies have shown that optimal adherence to prescribed medications significantly reduces the absolute and relative risks of mortality in patients with CAD. Despite the proven benefits, many patients fail to adhere to their medication regimens, leading to poorer health outcomes and increased healthcare costs.
Impact of Specific Medications on Coronary Flow Reserve
Research has demonstrated that certain cardiovascular medications can improve coronary flow reserve (CFR) in patients without significant stenosis of epicardial coronary arteries. Angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and statins have been associated with significant improvements in CFR. Calcium channel blockers (CCBs) also showed positive effects on CFR when used for 6 to 12 months, whereas beta-blockers and ranolazine did not show significant improvements.
Underuse of Effective Medications in Different Populations
Despite the availability of effective medications, their use remains suboptimal, particularly in certain populations. In the Asian region, there is a notable gap in the secondary prevention of CAD due to the underuse of evidence-based medications such as beta-blockers, ACE inhibitors, ARBs, aspirin, and lipid-lowering drugs. Similarly, in the United States, women, middle-aged adults, and racial/ethnic minorities are less likely to use effective cardiac medications compared to older adults, men, and non-Hispanic whites.
Medication Use Post-Angiography
Patients with nonobstructive CAD are less likely to receive optimal medical therapy (OMT) compared to those with obstructive CAD. This includes lower rates of prescriptions for ACEIs/ARBs, beta-blockers, and statins . Interestingly, there are no significant sex differences in medication use post-angiography, although females tend to use CCBs and clopidogrel more frequently than males.
Efficacy of Statins in Obstructive CAD
Statins have been shown to significantly reduce the risk of major adverse cardiovascular events (MACE) in patients with obstructive CAD diagnosed by coronary computed tomographic angiography (CCTA). Other medications, including aspirin, beta-blockers, ACE inhibitors, and ARBs, did not show a similar reduction in MACE risk.
Traditional and Alternative Treatments
In addition to conventional Western medications, traditional Chinese medicines like the Shexiang Baoxin Pill (SBP) have been used to treat CAD not amenable to revascularization. Long-term administration of SBP has been found to be effective and safe, with significant long-term benefits.
Conclusion
Cardiovascular medications play a vital role in the management and secondary prevention of CAD. However, adherence to these medications is essential to achieve the desired health outcomes. Despite the availability of effective treatments, there is a significant underuse of these medications in various populations, highlighting the need for targeted interventions to improve medication adherence and optimize patient care.
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