Translating the Secondary Prevention Therapeutic Boom Into Action.

For decades, patients with ischemic heart disease (IHD) and myocardial infarction (MI) have been treated with a ‘classic prevention cocktail’ including aspirin, P2Y12 inhibitor, betablocker, ACEi/ARB and statin therapy. This secondary prevention regimen has been partially responsible for the dramatic reduction in cardiovascular (CV) mortality in this country1. Yet, despite this, IHD patients still face up to 5-10% annual risk for recurrent events2. This ‘residual risk’ has spurred the development of multiple new therapies including novel antithrombotic regimens, non-statin lipid lowering therapies, anti-inflammatory agents, and cardioprotective anti-diabetic agents. While the blossoming of novel CV prevention therapeutics will provide a plethora of treatment opportunities for clinicians and their patients, it also raises many important questions for contemporary cardiac care. What constitutes the optimal combination of CV prevention therapies? Can such strategies be routinely implemented? And, if so, will patients be able to afford and durably stay on these regimens?