|Smoking: Goalcomplete cessation||Assess tobacco use. Strongly encourage patient and family to stop smoking and to avoid secondhand smoke. Provide counseling, pharmacological therapy (including nicotine replacement and bupropion), and formal smoking cessation programs as appropriate.|
|Blood pressure control: GoalLess than 140/90 mmHg or Less than 130/80 mmHg if chronic kidney disease or diabetes||If blood pressure is 120/80 mmHg or greater:|
|Lipid management:(TG less than 200 mg/dL) Primary goalLDL-C substantiallyless than 100 mg/dL||Start dietary therapy in all patients (less than 7% of total calories as saturated fat and less than 200 mg/d cholesterol). Promote physical activity and weight management. Encourage increased consumption of omega-3 fatty acids.|
|Assess fasting lipid profile in all patients, preferably within 24 hours of STEMI.|
|Add drug therapy according to the following guide:|
|LDL-C substantiallyless than 100 mg/dL (baseline or on-treatment):|
|LDL-C greater than or equal to 100 mg/dL (baseline or on-treatment):|
|Lipid management:(TG 200 mg/dL or greater)Primary goalNon-HDL-C⁎substantiallyless than 130 mg/dL||If TG is greater than or equal to 150 mg/dL or HDL-C is less than 40 mg/dL:|
|If TG is 200 to 499 mg/dL:|
|If TG is greater than or equal to 500 mg/dL:|
|Physical activity: Minimum goal30 minutes 3 to 4 days per week; Optimal daily|
|Weight management: GoalBMI 18.5–24.9 kg/m2Waist circumference: Women: Less than 35 inchesMen: Less than 40 inches|
|Diabetes management: GoalHbA1c less than 7%||Appropriate hypoglycemic therapy to achieve near-normal fasting plasma glucose, as indicated by HbA1c.Treatment of other risks (eg, physical activity, weight management, blood pressure, and cholesterol management).|
|Antiplatelet agents/anticoagulants:||Start and continue indefinitely aspirin 75 to 162 mg/d if not contraindicated. Consider clopidogrel 75 mg/d or warfarin if aspirin is contraindicated. Manage warfarin to INR of 2.5 to 3.5 in post-STEMI patients when clinically indicated or for those not able to take aspirin or clopidogrel (Figure 7).|
|Renin-Angiotensin-Aldosterone System Blockers:|
|Beta-Blockers:||Start in all patients. Continue indefinitely. Observe usual contraindications.|
BMI indicates body mass index; in, inches; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; BMI, body mass index; INR, international normalization ratio; ACE, angiotensin converting enzyme; CHF, congestive heart failure; LVEF, left ventricular ejection fraction; ARB, angiotensin receptor blocker and TG, triglycerides.
↵⁎ Non-HDL cholesterol equals total cholesterol minus HDL cholesterol.
↵† Treat to a goal of non-HDL-C substantiallyless than 130 mg/dL.
↵‡ Dietary-supplement niacin must not be used as a substitute for prescription niacin, and over-the-counter niacin should be used only if approved and monitored by a physician.
↵§ Creatinine should be less than or equal to 2.5 mg/dL in men or less than or equal to 2.0 mg/dL in women.
↵∥ Potassium should be less than or equal to 5.0 mEq/L.
Modified with permission from Smith et al. Circulation.2004;109:672–93 (181).