From the Guidelines
A comprehensive approach to preventing Major Adverse Cardiovascular Events (MACE) in at-risk patients requires a multifaceted strategy combining medication, lifestyle modifications, and regular monitoring. The cornerstone medications include statins (such as atorvastatin 20-80mg or rosuvastatin 10-40mg daily) to lower LDL cholesterol below target levels, antiplatelet therapy (aspirin 81-100mg daily) for those with established cardiovascular disease, and blood pressure management with ACE inhibitors (like ramipril 2.5-10mg daily) or ARBs (such as losartan 25-100mg daily) 1. For diabetic patients, SGLT2 inhibitors (empagliflozin 10-25mg daily) or GLP-1 receptor agonists should be considered regardless of glucose control status.
Essential lifestyle modifications include:
- Mediterranean or DASH diet adoption
- Regular physical activity (150 minutes of moderate exercise weekly)
- Smoking cessation
- Weight management targeting BMI below 25
- Stress reduction techniques
Regular monitoring should include:
- Quarterly blood pressure checks
- Annual lipid panels
- Diabetes screening
This comprehensive approach addresses multiple cardiovascular risk factors simultaneously, as atherosclerotic disease progression is influenced by various modifiable factors including lipid levels, inflammation, endothelial dysfunction, and thrombotic tendency 1. The combination of pharmacological interventions targeting specific pathways and lifestyle changes that improve overall cardiovascular health provides the most effective strategy for MACE prevention.
In patients with PAD, single antiplatelet therapy with aspirin or a P2Y12 inhibitor (such as clopidogrel or ticagrelor) is recommended to reduce the risk of MACE 1. Additionally, low-dose anticoagulation with rivaroxaban (2.5 mg twice daily) in addition to low-dose aspirin may be considered in patients with CVD who do not have a high risk of bleeding 1.
Aggressive risk factor management, including management of traditional cardiovascular risk factors such as diabetes, hypertension, smoking, and dyslipidemia, is also crucial in preventing MACE in patients with PAD 1. A multispecialty care team approach can promote collaboration and avoid potential duplication of care, and coordination of care is particularly important for risk factor management to optimize outcomes for these patients.
From the Research
Comprehensive Approach to Preventing MACE
To prevent Major Adverse Cardiovascular Events (MACE) in at-risk patients, a comprehensive approach is necessary. This approach involves identifying and managing risk factors, as well as implementing evidence-based strategies to reduce the risk of MACE.
Risk Factors for MACE
Several risk factors have been identified as contributing to the development of MACE, including:
- Diabetes 2
- Heart failure 3, 2
- Hypertension 3
- Hyperlipidaemia 2
- Smoking 2
- Older age 2
- Metabolic syndrome 4
- Atrial fibrillation 4
- Renal disease 3
- Peripheral vascular disease 3
- Cerebrovascular disease 3
Strategies to Prevent MACE
To prevent MACE, the following strategies can be implemented:
- Aggressive management of risk factors, such as hypertension, hyperlipidaemia, and diabetes 3, 2
- Use of evidence-based medications, such as statins, angiotensin-converting enzyme inhibitors, and beta-blockers 3
- Lifestyle modifications, such as smoking cessation, healthy diet, and regular exercise 2, 5
- Early identification and treatment of atrial fibrillation 4
- Use of risk prediction models, such as the 2MACE score, to identify patients at high risk of MACE 4
- Comprehensive risk assessment, including evaluation of cardiac energy metabolism substrate 6
Energy Metabolism Substrate and MACE
Recent studies have identified cardiac energy metabolism substrate as a potential predictor of MACE 6. The following factors have been identified as independent predictors of MACE:
- Age
- Albumin
- Free fatty acid
- Glucose
- Apolipoprotein A1 A nomogram based on these factors can provide accurate prognosis prediction and guide clinical decision-making 6.
Intensive Treatment and Early Intervention
Intensive treatment and early intervention are crucial in preventing MACE 5. This includes aiming for far lower goals in cholesterol management, taking into account many more factors than commonly employed today, and beginning treatment significantly earlier in life 5.