What are the drugs with good effect in treating coronary heart disease and angina pectoris?

The purpose of drug therapy for coronary heart disease is to relieve symptoms and reduce angina pectoris and myocardial infarction; Delaying the development of coronary atherosclerosis and reducing the death of coronary heart disease. Standardized drug therapy can effectively reduce the mortality and ischemic events of patients with coronary heart disease and improve their clinical symptoms. For some patients with severe vascular diseases or even complete obstruction, vascular reconstruction therapy can further reduce the mortality of patients on the basis of drug treatment.

(1) Nitrate drugs: nitroglycerin, isosorbide dinitrate (isosorbide dinitrate), isosorbide 5- mononitrate, long-acting nitroglycerin preparation (nitroglycerin ointment or plaster), etc. Nitrates are commonly used in patients with stable angina pectoris. When angina pectoris occurs, nitroglycerin can be taken sublingually or nitroglycerin aerosol can be used. For patients with acute myocardial infarction and unstable angina pectoris, the drug should be injected intravenously first. After the condition is stable and the symptoms improve, take it orally or apply it to the skin. After the pain symptoms disappear completely, you can stop taking the medicine. Continuous use of nitrate will lead to drug resistance and reduce its effectiveness. Nitrates can be taken at intervals of 8 ~ 12 hours to reduce drug resistance.

(2) Antithrombotic drugs include antiplatelet and anticoagulant drugs. Antiplatelet drugs mainly include aspirin, clopidogrel and tirofiban, which can inhibit platelet aggregation and prevent thrombosis from blocking blood vessels. Aspirin is the first choice, and the maintenance dose is 75 ~ 100 mg per day. All patients with coronary heart disease should take it for a long time if there are no contraindications. The side effect of aspirin is that it can stimulate the gastrointestinal tract, so patients with gastrointestinal ulcer should use it with caution. Clopidogrel should be taken orally every day after percutaneous coronary intervention, usually for half a year-1 year.

Anticoagulant drugs include ordinary heparin, low molecular weight heparin, fondaparinux sodium, bivalirudin, etc. It is usually used for unstable angina pectoris and acute myocardial infarction, and also for interventional therapy.

Beta-blockers Beta-blockers can not only relieve angina pectoris, but also prevent arrhythmia. In the absence of obvious contraindications, beta blockers are the first-line drugs to treat coronary heart disease. Commonly used drugs are: metoprolol, atenolol, bisoprolol, carvedilol and arolol (Almar). The dosage should be to reduce the heart rate to the target range. Contraindications and careful use of beta blockers include asthma, chronic bronchitis and peripheral vascular diseases.

Renin angiotensin system inhibitors include angiotensin converting enzyme inhibitors (ACEI), angiotensin 2 receptor antagonists (ARB) and aldosterone antagonists. For patients with acute myocardial infarction or recent myocardial infarction complicated with cardiac insufficiency, such drugs should be used especially. Commonly used ACEI drugs include enalapril, benazepril, ramipril and fosinopril. If dry cough has obvious side effects, angiotensin 2 receptor antagonist can be used instead. ARB includes valsartan, telmisartan, irbesartan and losartan. Attention should be paid to prevent hypotension during medication.

Lipid-regulating therapy is suitable for all patients with coronary heart disease. Statins are given to coronary heart disease on the basis of changing living habits. Statins mainly reduce low-density lipoprotein cholesterol, and the therapeutic goal is to reduce it to 80mg/dl. Commonly used drugs are lovastatin, pravastatin, simvastatin, fluvastatin and atorvastatin. Recent studies have shown that statins can reduce mortality and morbidity.