From the Guidelines
For this post-MI patient, I would recommend continuing the current medication regimen, which includes appropriate dual antiplatelet therapy (ASA and ticagrelor), beta-blocker (bisoprolol), ACE inhibitor (ramipril), and SGLT2 inhibitor (jardiance), and consider adding ezetimibe 10mg daily to further lower LDL cholesterol below 1.0 mmol/L for secondary prevention, as the current LDL of 1.16 mmol/L is close to but not below the target of <1.0 mmol/L for secondary prevention 1.
The patient's current medication regimen is excellent, with the use of beta-blockers, ACE inhibitors, and statins, which are all recommended in the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction 1. The guideline recommends the use of beta-blockers, such as metoprolol or carvedilol, in all patients without contraindication, and ACE inhibitors, such as lisinopril or ramipril, in patients with anterior infarction, post-MI LV systolic dysfunction, or heart failure.
Some key points to consider in this patient's management include:
- Continuing dual antiplatelet therapy with ASA and ticagrelor, as recommended in the guideline 1
- Maintaining blood pressure control, with a goal of <140/90 mmHg, as recommended in the guideline 1
- Adhering to lifestyle modifications, including a heart-healthy diet, regular physical activity, smoking cessation if applicable, and stress management
- Considering cardiac rehabilitation to improve functional capacity and reduce cardiovascular risk
- Monitoring for potential side effects of medications, such as hypotension, renal failure, and hyperkalemia, as outlined in the guideline 1
Overall, the combination of optimal medical therapy and lifestyle modifications will help reduce the risk of recurrent cardiovascular events in this patient.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Current Medication Regimen
The patient is currently taking:
- Aspirin (ASA)
- Ticagrelor (Ticag)
- Bisoprolol 2.5mg
- Ramipril 2.5mg
- Jardiance 10mg
- Crestor 40mg
Potential Additions to the Regimen
Based on the provided evidence, there are no clear indications to add any new medications to the patient's regimen. However, some considerations can be made:
- The use of sacubitril-valsartan in patients with acute myocardial infarction has been studied, but it was not found to be significantly more effective than ramipril in reducing the risk of death from cardiovascular causes or hospitalization for heart failure 2.
- The patient's current LDL level is 1.16, and they are already taking Crestor 40mg. No changes to their lipid-lowering therapy are indicated at this time.
Adherence to Medication Regimen
- A study found that patients with asymptomatic ischemic heart disease may adhere better to their medication regimen than those with symptomatic disease 3.
- Another study highlighted the importance of reviewing a patient's medication regimen in a systematic manner to identify potential problems and simplify the regimen 4.
Management of Antiplatelet Therapy
- The use of ticagrelor in acute myocardial infarction has been studied, and it was found to be effective in reducing the risk of ischemic events 5.
- A study comparing ticagrelor and aspirin to aspirin alone in patients with acute ischemic stroke or TIA found that the combination of ticagrelor and aspirin was more effective in reducing the risk of stroke or death, but was associated with a higher risk of severe bleeding 6.
Blood Pressure Management
- The patient's current blood pressure is 115/70 mmHg, which is within a normal range. No changes to their antihypertensive therapy are indicated at this time.