Update to Evidence-Based Secondary Prevention Strategies Post-Acute Coronary Syndrome (ACS)

Abstract A recent acute coronary syndrome (ACS) provides an opportunity to optimise secondary prevention strategies to reduce the risk of future cardiovascular events. This review provides an updated synopsis of current evidence-based approaches. New clinical trial data on the use of antiplatelet and anticoagulants allows choices of the selection and duration of treatment. Lipid lowering after an ACS is now enhanced, with proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors providing added benefit on top of statin and ezetimibe treatment in high risk patients. In addition, a recent trial of icosapent ethyl, a highly purified ethyl ester of eicosapentaenoic acid (EPA), addresses residual risk in patients with elevated triglycerides already treated with statins. The use of both sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes reduces CV events independent of glucose lowering. Summary: A recent acute coronary syndrome (ACS) provides an opportunity to optimise secondary prevention strategies to reduce the risk of future cardiovascular events. Controlling cardiovascular risk factors with agents that have been shown to be effective in reducing adverse outcomes is the goal of secondary prevention. The current review adds recent information about the use of antiplatelet agents, lipid management and the benefit of glucose lowering agents with proven CVD prevention