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Hjerteinfarkt, angina pectoris og stentbehandling av hjertets koronararterier betyr at det foreligger koronarsykdom. Forebyggende behandling hos disse pasientene gir færre dødsfall, færre nye hjerteinfarkt og færre andre komplikasjoner.

  • Sist endret: 17.11.2014
  • Sist revidert: 17.11.2014

Forebyggende medisiner ved koronarsykdom

Blodplatehemmere

Bruk av blodplatehemmere, Albyl-E i dose på 75-100 mg, anbefales til alle i sekundærforebyggingen av koronarsykdom24Boersma E, Harrington RA, Moliterna DJ, et al. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomised clinical trials. Lancet 2002; 359: 189-98. PubMed. I en stor meta-analyse reduserte blodplatehemmere risikoen for nye hjertekarsykdommer med 25%25Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71-86. BMJ. Behandlingen med Albyl-E bør starte umiddelbart etter at diagnosen koronarsykdom er stilt og fortsette livet ut3Thompson PD, Buchner D, Pina IL, et al., for the American Heart Association. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 2003; 107: 3109-16. Circulation,25Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71-86. BMJ. En annen type blodplatehemmer, klopidogrel (Plavix), er et effektivt alternativ hos pasienter som ikke kan ta Albyl-E. En kombinasjon av ASA + klopidogrel anbefales i opptil 12 mnd etter en akutt koronar hendelse med innsetting av stent i koronararterien25Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71-86. BMJ.

Betablokker

Alle med gjennomgått hjerteinfarkt tilrås behandling med betablokker livet ut dersom det ikke foreligger kontraindikasjoner3Thompson PD, Buchner D, Pina IL, et al., for the American Heart Association. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation 2003; 107: 3109-16. Circulation,26Eagle KA, Guyton RA, Davidoff R, et al., for the American College of Cardiology, American Heart Association Task Force on Practice Guidelines, American Society for Thoracic Surgery and the Society of Thoracic Surgeons. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 2004; 110: 1168-76. Circulation. En rekke studier har vist at betablokkere reduserer risikoen for å få et nytt hjerteinfarkt, plutselig død og død i forbindelse med et nytt hjerteinfarkt27Freemantle N, Cleland J, Young P, Mason J, Harrison J. Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 1999; 318: 1730-7. BMJ.

Statinbehandling

Statin er et fellesnavn på de legemidlene vi idag bruker til å redusere kolesterolmengden i blodet. Statiner, for eksempel simvastatin, anbefales til så godt som alle med koronarsykdom uansett kolesterolverdi, og i alle fall ved totalkolesterol høyere enn 5,0 mmol/L eller LDL-kolesterol høyere enn 3,0 mmol/L. Reduksjon av kolesterolnivået reduserer risikoen for ny koronarsykdom28-3028. Koren MJ, Hunninghake DB, for the ALLIANCE Investigators. Clinical outcomes in managed-care patients with coronary heart disease treated aggressively in lipid-lowering disease management clinics: the alliance study. J Am Coll Cardiol 2004; 44: 1772-9. PubMed
29. Baigent C, Keech A, Kearney PM, et al., for the Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366: 1267-78. PubMed
30. Josan K, Majumdar SR, McAlister FA. The efficacy and safety of intensive statin therapy: a meta-analysis of randomized trials. CMAJ 2008; 178: 576-84. CMAJ
. De med høyest risiko har størst gevinst31Baigent C, Keech A, Kearney PM, et al for the Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366: 1267-78. PubMed.

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