Table 1.

Secondary coronary prevention measures following myocardial infarction.

Established efficacy following myocardial infarction
Aspirin	Dose 75–300 mg daily. Lower doses are equally efficacious but have less gastrotoxicity. Alternative antiplatelet drugs are also effective.
β-adrenoceptor blocker	Recognized cautions and contra-indications include severe cardiac failure, reversible airways obstruction and peripheral vascular insufficiency.
ACE inhibitor	Indicated for those with evidence of impaired left ventricular function.
Statins	Indicated for those in whom diet has failed or is unlikely to achieve target cholesterol reductions total cholesterol < 5.0 mmol l−1 or LDL cholesterol < 3.0 mmol l−1.
Lifestyle factors	Smoking cessation, dietary modification, aerobic exercise.

Potentially beneficial interventions following myocardial infarction
Anticoagulation	Superiority over antiplatelet therapy alone has not been established. May be indicated for other reasons in postinfarct patients e.g. dysrrhythmia or ventricular aneurysm.
Amiodarone	May offer benefits in subgroups at high risk of arrhythmic death postinfarct.
Revascularization	CABG offers mortality benefits over medical therapy in left mainstem disease and patients with triple vessel disease and impaired left ventricular function. PTCA not of proven benefit largely because of the high rates of restenosis.
Hormone replacement therapy	Exogenous oestrogens have apparently beneficial effects and seem to offer cardioprotective benefits in observational studies, alone and in combination with progestogens. No proven benefit demonstrated in prospective studies.
Antioxidants	Promising epidemiological data but no evidence of a mortality benefit in prospective trials.