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Invited Commentary
January 2, 2020

Translating the Secondary Prevention Therapeutic Boom Into Action

Author Affiliations
  • 1Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
JAMA Cardiol. Published online January 2, 2020. doi:10.1001/jamacardio.2019.4959

For decades, patients with ischemic heart disease (IHD) and myocardial infarction (MI) have been treated with a “classic prevention cocktail,” including aspirin, P2Y12 inhibitor, β-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and statin therapy. Widespread use of this secondary prevention regimen has been partially responsible for the reduction in cardiovascular (CV) mortality in the United States.1 Yet, despite this, patients with IHD still face up to 5% to 10% annual risk for recurrent events.2 This residual risk has spurred the development of multiple new therapies, including novel antithrombotic regimens, nonstatin lipid-lowering therapies, anti-inflammatory agents, and cardioprotective antidiabetic agents. While the emerging CV prevention therapeutics will provide many treatment opportunities for clinicians and their patients, it also raises many questions for contemporary cardiac care. What constitutes the optimal combination of CV prevention therapies? Can such strategies be routinely implemented? If so, will patients be able to afford and durably maintain these regimens?