Secondary prevention with β-adrenergic blockers and aspirin in ischemic heart disease

β-Adrenergic blockers and aspirin have been shown conclusively to be effective therapies for reducing the long-term risk of mortality and nonfatal reinfarction in survivors of acute myocardial infarction. Both treatments have also been demonstrated to be of benefit when administered during the hyperacute phase of myocardial infarction to patients with and without concomitant thrombolysis. There have been no studies comparing combination aspirin and β-blocker therapy to either treatment alone; however, they are probably most effective when used together. The benefit of aspirin appears to be related to its antiplatelet and antithrombotic activities. The benefit of β-adrenergic blockade was assumed to be related to its antiarrythmic and myocardial oxygen demand-reducing effects. It is proposed that an antithrombotic effect may also be an important related action of β-blockers in reducing the risk of atherosclerotic plaque fissure and subsequent thrombosis.