Chin Jialiang, Fulcher Jordan, Jenkins Alicia, Keech Anthony
National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Level 6 Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, NSW 2050, Australia.
National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Level 6 Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, NSW 2050, Australia; Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
Heart Lung Circ. 2015 May;24(5):480-7. doi: 10.1016/j.hlc.2014.11.016. Epub 2014 Nov 29.
Optimising secondary prevention of cardiovascular disease has the greatest potential to reduce recurrent events, yet despite major guidelines there are ongoing treatment gaps. FFSAABC (Fish oils, Fibrates, Statins, Aspirin, Angiotensin converting enzyme inhibitors or angiotensin 2 receptor antagonists, Beta blockers and Clopidogrel) is one mnemonic previously adopted to assist clinicians in remembering medications for use in secondary prevention. The aim of this narrative review is to examine the current evidence base for medications recommended for patients with established cardiovascular disease and the current applicability of this, or a revised mnemonic for their use.
Randomised controlled trials and systematic reviews were sought examining Fish oils, Fibrates, Statins, Aspirin, Angiotensin converting enzyme inhibitors or angiotensin 2 receptor antagonists, Beta blockers or Clopidogrel vs placebo in secondary prevention. The emerging evidence base for other contemporary therapies including the P2Y12 inhibitors (ticagrelor and prasugrel) and aldosterone antagonists was also reviewed.
Definitive evidence supports the use of statins, aspirin, angiotensin converting enzyme inhibitors or angiotensin 2 receptor antagonists, and P2Y12 antagonists (clopidogrel, ticagrelor or prasugrel) for the secondary prevention of cardiovascular disease. Aldosterone antagonists have strong evidence in the presence of systolic heart failure. There is a weaker evidence base for the routine use of omega-3 fatty acid supplementation although this therapy carries minimal harms. Fenofibrate reduces cardiovascular events in dyslipidaemic patients, with additional benefits in patients with diabetes.
Mnemonic upgrading from a Fairly Fast SAAB Convertible to a Fairly Fast SA(2)A(2)B (Fish oils, Fibrate, Statin, Antiplatelets (Aspirin+Other), ACE/ARB, Aldosterone Antagonist, Beta-blocker) may help to ensure patients receive best practice evidence-based pharmacotherapies for the secondary prevention of cardiovascular disease.
优化心血管疾病的二级预防对于减少复发事件具有最大潜力，但尽管有主要指南，治疗差距仍持续存在。FFSAABC（鱼油、贝特类药物、他汀类药物、阿司匹林、血管紧张素转换酶抑制剂或血管紧张素2受体拮抗剂、β受体阻滞剂和氯吡格雷）是先前采用的一种助记符，以帮助临床医生记住用于二级预防的药物。本叙述性综述的目的是研究针对已确诊心血管疾病患者推荐药物的当前证据基础，以及该助记符或其修订版在当前的适用性。
检索随机对照试验和系统评价，比较鱼油、贝特类药物、他汀类药物、阿司匹林、血管紧张素转换酶抑制剂或血管紧张素2受体拮抗剂、β受体阻滞剂或氯吡格雷与安慰剂在二级预防中的效果。还综述了包括P2Y12抑制剂（替格瑞洛和普拉格雷）和醛固酮拮抗剂在内的其他当代疗法的新证据基础。
确凿证据支持使用他汀类药物、阿司匹林、血管紧张素转换酶抑制剂或血管紧张素2受体拮抗剂以及P2Y12拮抗剂（氯吡格雷、替格瑞洛或普拉格雷）进行心血管疾病的二级预防。醛固酮拮抗剂在收缩性心力衰竭患者中有强有力的证据支持。常规使用ω-3脂肪酸补充剂的证据基础较弱，尽管该疗法危害极小。非诺贝特可降低血脂异常患者的心血管事件，对糖尿病患者有额外益处。
助记符从“相当快的萨博敞篷车”升级为“相当快的SA(2)A(2)B”（鱼油、贝特类药物、他汀类药物、抗血小板药物（阿司匹林+其他）、ACE/ARB、醛固酮拮抗剂、β受体阻滞剂）可能有助于确保患者接受基于最佳实践证据的药物治疗，用于心血管疾病的二级预防。
