Yes, he needs to continue those drugs in addition to diet and life sthle medication. Drugs, lifestyle modifications and risk factors control all together may give ardsult equivalent to bypas surgery or sngioasty in patients with stable coronary hesrt disease.

After angioplasty or stenting or any patient of established Ischemic heart disease, should get Statin, preferably Rusuvastatin or Atorvastatin & It's better to take high doses & to maintain LDL level < 70 mg/dl.

Regarding Ramipril, it’s also most important to reduce BP & along with prevention of cardiac remodeling as well. Yes these medication along with Life style change & dietary control also important for the patient.

Thanks for raising valuable question.

Hi Dr Ayaz Ali Samo . In people with heart failure, ramipril decreases the size of the heart and increases how much blood the heart can pump out. It also increases exercise tolerance, without having much of an effect on heart rate. See the link: https://www.drugs.com/tips/ramipril-patient-tips

According to guidelines, statins are a must for secondary prevention and if the person is at high risk, statins are also indicated. The risk level is defined by the famous chart. If a person is already diagnosed as a cardiac patient then no argument he must take statins. Risk factors are the presence of diabetes or not, smoker or not, age, male gender, level of cholesterol, family history, obesity (body mass index > 30, presence of coronary disease is a risk for another attack, any vascular disease peripheral or cerebral.

The dose is moderate intensity statine or high intensity according to a high-risk patient or not.

About ACEi they are beneficial in improving endothelial function and other pleiotropic effects.

As you say he is a cardiac patient so he must continue on both for life besides lifestyle modification.

Samir Rafla, emeritus professor of cardiology at Alexandria University.

References

1. Martin Czerny et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal (2019)00,171

2. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 140(11):e596–e646.doi:10.1161/CIR.0000000000000678

As previously noted, statins are mandatory and rosuvastatin is best, but must be given a a dose sufficient to lower LDL-c to 70 mg/dl (1.75 mmoles/L) if HDL-c is measured by the enzymatic method, but to 80 mg/dl (2.0 mmoles/L) if the precipitation method is used. Whatever it takes to achieve this goal. I would recommend adding a calcium channel blocker it needed to get the systolic blood pressure under control.

Absolutely he must continue to take those drugs, and ACE inhibitors or beta Blocker inhibitors with diet modification

Just to add: statins do a lot more than just lower LDL-c. They have anti-clotting properties and vasodilitory properties, releasing nitric oxide in the artery wall. This may also account for their anti-inflammatory effects.

Any CAD patient , who underwent angioplasty, usually Doctors prescribed Hypolipidemic drugs , recently preferred one Rosuvastatin, or Atorvastatin and Blood pressure lowering drugs like Beta-blocker metoprolol or Calcium channel blocker like Ramipril due to underlying cause of CAD ( Hypercholesterolemia , Hypertension ) . This drug prevent futher post angioplasty restenosis and control Hear Rate and Improve Coronary Perfusion by decreasing myocardial Oxygen Demand. Drugs, Life style modification in the form of diets devoid of cholesterol and Risk factors modification helping in to prevent the acceleration of underlying disease process. By doing the strict diets control, dose of Hypolipidemic drugs and antihypertensive drug may decrease.

Any patient with established cardiovascular disease after angioplasty needs a high-intensity dose of statin, an ACE inhibitor (or ARB) in addition to dual antiplatelets for at least one year (followed by single antiplatelet agent) in addition to life-style modification along with control of other risk factors like diabetes mellitus.

Any patient with established atherosclerotic cardiovascular disease (evident as angina, acute coronary syndrome, TIA, ischemic stroke, peripheral vascular disease or any one who underwent angioplasty or CABG) needs life-long intensive dose statin therapy (Rosuvastatin 20-40 mg daily as an example). Even if the patient has normal or low BP, such patients also need and ACE inhibitor (Ramipril or any other) or ARB to achieve long-term benefits on cardiovascular re-modelling).

Such patients in addition need dual antiplatelets (typically aspirin plus clopidogrel) at least one year after angioplasty after which one of the antiplatelet can be stopped.

Main stay of Treatment after Angioplasty is Rosuvastatin or Atorvastatin , ACE inhibitor or ACEB or Beta blockers , Dual antiplatelet drugs ( Clopidegrol and Aspirin) along with life style modification ( Cholesterol free diet, Salt restriction ) , Aerobic exercise . Definitely Diet modification will prevent the acceleration of diseases.

Good morning,

For complex reasons, both medicines are recomanded. The answer, is Yes use them both. The amount per pil should be personalized. Best regards.

All the drugs is being used after coronary angioplasty , Statin poses unique properties of anti clotting , vasodilatory properties , must be continue along with other essential drugs

Short answer -yes.

The answer is YES. But I do not agree with the "mandatory" qualifier. The patient should be informed on the reasons for the recommendation (RCT .. bla bla bla, that have shown improved outcomes, no immunity for further events). The patient is who decides. Our role is to guide him/her to make a well informed final decision, no one else.

Moreover, I wonder if I would prescribe a statin to this patient if he/she lost 80 Lbs of weight and the LDL is less than 30 with diet alone. Probably NO.

Similarly, after PCI - without heart failure - would I prescribe or recommend an ACEI if the BP is 100/60? Probably NO.

I believe, medicine is still an art and remember, every patient is different, and guidelines are just that, guidelines - no laws.

Yes D Manyari Sir. I am agree with your statement Treatment should be tailored to each and every patients according bro need of that individual patient.

Life style modification ( Cholesterol free diet ) is one of the corner of Triangle for Post angioplasty Patients. Other corner of Triangle are Calcium channel blocker or ACEB/AcE inhibitors , Statins and Dual antiplatelet therapy. Life style modification is most important adjunct to prevent Post Stenting stenosis.

Any Patients with established CAD , undergoing Angioplasty , usually prescribed drugs are ACE inhibitors ( Ramipril) ,Dual antiplatelet drug ( Aspirin and Clopidegrol) and Statins ( Rosuvastatin) , Ramipril posing unique properties , besides lowering down Lying down and standing blood pressure without orthostatic hypotension ( unless patient is dehydrated) . This drug delaybthe progression of Kidney disease particularly in Diabetic ,who are usually prone for CAD. Definitely Diet control will play as adjunct role