What are the key pharmacological treatments for secondary prevention of myocardial infarction that I should prescribe?

For secondary prevention of myocardial infarction (MI), the key pharmacological treatments you should prescribe include:

• Angiotensin-converting enzyme (ACE) inhibitors: Offer to all people who have had an MI, starting as soon as they are haemodynamically stable, and continue indefinitely with dose titration to the maximum tolerated or target dose ¹.
• Beta-blockers: Offer to all people after an MI, continuing for at least 12 months. For those with reduced left ventricular ejection fraction, continue indefinitely ¹.
• Dual antiplatelet therapy (DAPT): Offer aspirin plus a second antiplatelet agent (e.g., clopidogrel or ticagrelor) for up to 12 months unless contraindicated. Aspirin should be continued indefinitely unless contraindicated ¹.
• Statins: Prescribe statin therapy for all adults with clinical evidence of cardiovascular disease for lipid lowering ¹.
• Angiotensin II receptor blockers (ARBs): Offer as an alternative to ACE inhibitors in people intolerant to ACE inhibitors ¹.
• Aldosterone antagonists: Consider in people with symptoms and/or signs of heart failure and reduced left ventricular ejection fraction post-MI, preferably after ACE inhibitor therapy ¹.

Additional considerations include monitoring renal function, serum potassium, and blood pressure during treatment, and assessing bleeding risk before and during antiplatelet therapy ¹.