Clinical indication		Drug		Evidence
Status post MI, CAD, transient ischemic attacks, stable and unstable angina, peripheral vascular disease, stroke prevention, and embolic stroke prevention in those unable to take warfarin (Coumadin)		Aspirin, 75 mg per day		Beneficial; most benefit seen for high-risk patients taking medium-dose aspirin for at least three years; should probably be used for life; no clear evidence of use in low-risk patients.29 [Evidence level A, systematic review of RCTs]
Status post MI		Beta blockers		Beneficial; given within hours of infarction and continued for at least one year or until a complication contraindicates use; most benefit found for those older than 65 years and those who suffered large infarcts.30,31 [Reference 30, Evidence level B, retrospective cohort study; Reference 31, Evidence level A, meta-analysis]
Hypertension		Thiazide diuretic Beta blocker ACE inhibitor		Any reduction in BP appears to confer benefit; treatment of BP reduces stroke, CHD, cardiovascular disease, heart failure, and mortality; treatment goal is BP < 140/90 mm Hg; however, an interim goal of systolic BP below 160 mm Hg may be needed in those with marked systolic hypertension; JNC VI recommends starting BP treatment with a low-dose thiazide diuretic or beta blockers in combination with thiazide diuretics.32,33 [References32 and 33, Evidence level A, meta-analyses]
	Systolic hypertension Status post MI/CAD CHF/DM
	Heart failure	ACE inhibitor (no significant difference between ACE inhibitors).34 Spironolactone (Aldactone, 12.5 to 25.0 mg per day)36		Beneficial; reduction in mortality, admission to hospitals, and ischemic events.34,35 [References 34 and 35, Evidence level A, meta-analyses] Spironolactone additive effect in reduction of morbidity and death with severe heart failure (NYHA III-IV).36 [Evidence level A, RCT]
	Hypercholesterolemia	Statins		Beneficial; consider treatment for patients 50 to 80 years of age
			Start with one half lowest recommended dose and titrate upward to target LDL level Baseline liver function tests with repeat test after six to 12 weeks of therapy, then twice yearly	without CAD who have serum LDL levels > 130 mg per dL (3.35 mmol per L) and serum HDL levels < 50 mg per dL (1.30 mmol per L) because older patients are at increased risk of CAD. Treat all men and women with CAD, previous stroke, DM, peripheral artery disease, extracranial carotid arterial disease, and abdominal aortic aneurysm to LDL level < 100 mg per dL (2.59 mmol per L). Active liver disease is a contraindication; a history of liver disease and alcohol use requires cautious use. Myopathy can be a problem; have patients report any unusual muscle tenderness.37 [Evidence level A, systematic review of RCTs]
	Chronic nonvalvular atrial fibrillation	Warfarin to maintain an INR between 2.0 and 3.0		Beneficial; as primary prevention, about 25 strokes and about 12 disabling fatal strokes would be prevented yearly for every 1,000 patients given oral anticoagulation therapy. Careful monitoring of INR required to offset potential hemorrhagic risk.38,39 [References 38 and 39, Evidence level A, meta-analyses]