Secondary Prevention After Myocardial Infarction: Bridging Evidence to Practice

Authors

  • Kevin Haddad, MD, MSc Centre Hospitalier de l’Université de Montréal (CHUM) Research Center, Montreal, Quebec, Canada.
  • Laurie-Anne Boivin-Proulx, MD, MSc University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
  • Samer Mansour, MD Centre Hospitalier de l’Université de Montréal (CHUM) Research Center, Montreal, Quebec, Canada.

DOI:

https://doi.org/10.58931/cct.2025.129

Abstract

Management of acute coronary syndrome (ACS) has advanced significantly over the past years, with various strategies shown to improve patient survival and reduce cardiovascular (CV) adverse events. An expanding body of literature supports the efficacy of both pharmacologic and non-pharmacologic approaches after acute myocardial infarction (MI). This review aims to provide a comprehensive overview of the secondary prevention strategies after acute MI in the modern era, with a particular focus on recent guidelines and their application in Canadian healthcare practice.

Author Biographies

Kevin Haddad, MD, MSc, Centre Hospitalier de l’Université de Montréal (CHUM) Research Center, Montreal, Quebec, Canada.

Dr. Haddad is a cardiologist trained at the University of Montreal, currently pursuing an Interventional Cardiology Fellowship at New York-Presbyterian/Columbia University Irving Medical Center. He has been actively involved in cardiology research with a focus on complex coronary interventions, CTO PCI, and secondary prevention. Dr. Haddad also completed formal training in epidemiology and clinical research at Harvard University. He  has  amassed more than 20 publications, either as the primary author or co-author, presented more than 15 scientific abstracts both in oral or poster formats, moderated several conference sessions, and been involved in nearly 20 distinct research projects within the field of cardiology. Dr. Haddad was additionally engaged in administrative and educational responsibilities within Quebec and across Canada. He is planning to return to the University of Montreal Hospital Center (CHUM) upon completion of his fellowship.

Laurie-Anne Boivin-Proulx, MD, MSc, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

Dr. Boivin-Proulx is currently completing an Interventional Cardiology fellowship (PGY9) at the University of Ottawa Heart Institute (Canada) and a PHD candidate at the Universidad Complutense de Madrid (Spain), with the goal of becoming a clinician-researcher with an interest in coronary physiology, microcirculation and women’s heart health. After her doctorate in medicine at the University of Sherbrooke (2016), she completed her residency in internal medicine (2020) and Cardiology (2023) at the University of Montreal, followed by a fellowship in Interventional Cardiology at the University of Ottawa Heart Institute (2023). In addition to her medical training, she also completed a Master of Sciences (MSc) in Epidemiology at Harvard T.H. Chan of Public Health (2021). Throughout her training, she has been involved in clinical research (54 publications; 32 conference presentations; 22 poster presentations) and with numerous national and international organizations. She currently is the national trainee representative and an executive board member of the Canadian Society of Cardiology (CCS), and of the Canadian Women’s Heart Health Alliance (CWHHA).

Samer Mansour, MD, Centre Hospitalier de l’Université de Montréal (CHUM) Research Center, Montreal, Quebec, Canada.

Dr. Mansour is a distinguished cardiologist, interventional cardiologist, and researcher at the University of Montreal Hospital Center (CHUM), as well as a full professor at the Faculty of Medicine of the University of Montreal. His distinguished contributions span several areas of cardiology, from diagnosis and investigation to treatment of heart disease, including coronary artery disease, heart failure, and arrhythmias. As Director of Clinical Research and the Cell Therapy Program in the Cardiology Department of the CHUM, as well as Director of the Cardiac Catheterization Laboratory at the Cité de la Santé Hospital in Laval, Dr. Mansour holds a leading position in the field of cardiovascular research in Quebec and Canada. A medical graduate of the Lebanese University, Dr. Mansour completed his specialization in internal medicine before specializing in cardiology at the University of Montreal. He then pursued a sub-specialization in interventional cardiology at the Paris-Sud Cardiovascular Institute in France. His academic and professional career also led him to conduct clinical research in cell therapy at the Aalst Cardiovascular Center in Belgium. With over 125 peer-reviewed publications and over 350 abstracts to his credit, Dr. Mansour is a prolific researcher whose expertise and contributions have had a significant impact on the field of cardiology.

References

Rao SV, O’Donoghue ML, Ruel M, Rab T, Tamis-Holland JE, Alexander JH, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;151(13):e771–e862. doi:10.1161/cir.0000000000001309 DOI: https://doi.org/10.1161/CIR.0000000000001328

Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023;148(9):e9–e119. doi:10.1161/cir.0000000000001168 DOI: https://doi.org/10.1161/CIR.0000000000001183

Rabi DM, McBrien KA, Sapir-Pichhadze R, Nakhla M, Ahmed SB, Dumanski SM, et al. Hypertension Canada’s 2020 Comprehensive Guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children. Can J Cardiol. 2020;36(5):596–624. doi:10.1016/j.cjca.2020.02.086 DOI: https://doi.org/10.1016/j.cjca.2020.02.086

Pearson GJ, Thanassoulis G, Anderson TJ, Barry AR, Couture P, Dayan N, et al. 2021 Canadian Cardiovascular Society Guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in adults. Can J Cardiol. 2021;37(8):1129–1150. doi:10.1016/j.cjca.2021.03.016 DOI: https://doi.org/10.1016/j.cjca.2021.03.016

Stone JA, Houlden RL, Lin P, Udell JA, Verma S. Cardiovascular protection in people with diabetes. Can J Diabetes. 2018;42 Suppl 1:S162–s169. doi:10.1016/j.jcjd.2017.10.024 DOI: https://doi.org/10.1016/j.jcjd.2017.10.024

Bainey KR, Marquis-Gravel G, Belley-Côté E, Turgeon RD, Ackman ML, Babadagli HE, et al. Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology 2023 Focused Update of the Guidelines for the Use of Antiplatelet Therapy. Can J Cardiol. 2024;40(2):160–181. doi:10.1016/j.cjca.2023.10.013 DOI: https://doi.org/10.1016/j.cjca.2024.05.001

Choi KH, Park YH, Lee JY, Jeong JO, Kim CJ, Yun KH, et al. Efficacy and safety of clopidogrel versus aspirin monotherapy in patients at high risk of subsequent cardiovascular event after percutaneous coronary intervention (SMART-CHOICE 3): a randomised, open-label, multicentre trial. Lancet. 2025;405(10486):1252–1263. doi:10.1016/s0140-6736(25)00449-0 DOI: https://doi.org/10.1016/S0140-6736(25)00449-0

Eikelboom JW, Connolly SJ, Bosch J, Dagenais GR, Hart RG, Shestakovska O, et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017;377(14):1319–1330. doi:10.1056/NEJMoa1709118 DOI: https://doi.org/10.1056/NEJMoa1709118

Bainey KR, Welsh RC, Connolly SJ, Marsden T, Bosch J, Fox KAA, et al. Rivaroxaban plus aspirin versus aspirin alone in patients with prior percutaneous coronary intervention (COMPASS-PCI). Circulation. 2020;141(14):1141–1151. doi:10.1161/circulationaha.119.044598 DOI: https://doi.org/10.1161/CIRCULATIONAHA.119.044598

Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111–188. doi:10.1093/eurheartj/ehz455 DOI: https://doi.org/10.1093/eurheartj/ehz455

Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344(8934):1383–1389. DOI: https://doi.org/10.1016/S0140-6736(94)90566-5

Schwartz GG, Olsson AG, Ezekowitz MD, Ganz P, Oliver MF, Waters D, et al. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. Jama. 2001;285(13):1711–1718. doi:10.1001/jama.285.13.1711 DOI: https://doi.org/10.1001/jama.285.13.1711

Sabatine MS, Giugliano RP, Keech AC, Honarpour N, Wiviott SD, Murphy SA, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med. 2017;376(18):1713–1722. doi:10.1056/NEJMoa1615664 DOI: https://doi.org/10.1056/NEJMoa1615664

Schwartz GG, Steg PG, Szarek M, Bhatt DL, Bittner VA, Diaz R, et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med. 2018;379(22):2097–2107. doi:10.1056/NEJMoa1801174 DOI: https://doi.org/10.1056/NEJMoa1801174

O’Donoghue ML, Giugliano RP, Wiviott SD, Atar D, Keech A, Kuder JF, et al. Long-term evolocumab in patients with established atherosclerotic cardiovascular disease. Circulation. 2022;146(15):1109–1119. doi:10.1161/circulationaha.122.061620 DOI: https://doi.org/10.1161/CIRCULATIONAHA.122.061620

Cannon CP, Blazing MA, Giugliano RP, McCagg A, White JA, Theroux P, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015;372(25):2387–2397. doi:10.1056/NEJMoa1410489 DOI: https://doi.org/10.1056/NEJMoa1410489

Nissen SE, Lincoff AM, Brennan D, Ray KK, Mason D, Kastelein JJP, et al. Bempedoic Acid and cardiovascular outcomes in statin-intolerant patients. N Engl J Med. 2023;388(15):1353–1364. doi:10.1056/NEJMoa2215024 DOI: https://doi.org/10.1056/NEJMoa2215024

Wright RS, Raal FJ, Koenig W, Landmesser U, Leiter LA, Vikarunnessa S, et al. Inclisiran administration potently and durably lowers LDL-C over an extended-term follow-up: the ORION-8 trial. Cardiovasc Res. 2024;120(12):1400–1410. doi:10.1093/cvr/cvae109 DOI: https://doi.org/10.1093/cvr/cvae109

Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med. 2019;380(1):11–22. doi:10.1056/NEJMoa1812792 DOI: https://doi.org/10.1056/NEJMoa1812792

Sayah, Neila et al. “Icosapent ethyl following acute coronary syndrome: the REDUCE-IT trial.” European heart journal vol. 45,13 (2024): 1173-1176. doi:10.1093/eurheartj/ehad889 DOI: https://doi.org/10.1093/eurheartj/ehad889

Opie LH. The new trials: AIRE, ISIS-4, and GISSI-3. Is the dossier on ACE inhibitors and myocardial infarction now complete? Cardiovasc Drugs Ther. 1994;8(3):469–472. doi:10.1007/bf00877924 DOI: https://doi.org/10.1007/BF00877924

Pfeffer MA, Claggett B, Lewis EF, Granger CB, Køber L, Maggioni AP, et al. Angiotensin receptor-neprilysin inhibition in acute myocardial infarction. N Engl J Med. 2021;385(20):1845–1855. doi:10.1056/NEJMoa2104508 DOI: https://doi.org/10.1056/NEJMoa2104508

Pitt B, Williams G, Remme W, Martinez F, Lopez-Sendon J, Zannad F, et al. The EPHESUS trial: eplerenone in patients with heart failure due to systolic dysfunction complicating acute myocardial infarction. Eplerenone Post-AMI Heart Failure Efficacy and Survival Study. Cardiovasc Drugs Ther. 2001;15(1):79–87. doi:10.1023/a:1011119003788 DOI: https://doi.org/10.1023/A:1011119003788

Jolly SS, d’Entremont MA, Pitt B, Lee SF, Mian R, Tyrwhitt J, et al. Routine spironolactone in acute myocardial infarction. N Engl J Med. 2025;392(7):643–652. doi:10.1056/NEJMoa2405923 DOI: https://doi.org/10.1056/NEJMoa2405923

Yndigegn T, Lindahl B, Mars K, Alfredsson J, Benatar J, Brandin L, et al. Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. 2024;390(15):1372–1381. doi:10.1056/NEJMoa2401479 DOI: https://doi.org/10.1056/NEJMoa2401479

Silvain J, Cayla G, Ferrari E, Range G, Puymirat E, Delarche N, et al. Beta-Blocker interruption or continuation after myocardial infarction. N Engl J Med. 2024;391(14):1277–1286. doi:10.1056/NEJMoa2404204 DOI: https://doi.org/10.1056/NEJMoa2404204

Ali MU, Mancini GBJ, Fitzpatrick-Lewis D, Lewis R, Jovkovic M, Zieroth S, et al. The effectiveness of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists on cardiorenal outcomes: systematic review and meta-analysis. Can J Cardiol. 2022;38(8):1201–1210. doi:10.1016/j.cjca.2022.05.011 DOI: https://doi.org/10.1016/j.cjca.2022.05.011

Mancini GBJ, O’Meara E, Zieroth S, Bernier M, Cheng AYY, Cherney DZI, et al. 2022 Canadian Cardiovascular Society Guideline for Use of GLP-1 receptor agonists and SGLT2 inhibitors for cardiorenal risk reduction in adults. Can J Cardiol. 2022;38(8):1153–1167. doi:10.1016/j.cjca.2022.04.029 DOI: https://doi.org/10.1016/j.cjca.2022.10.008

Lincoff AM, Brown-Frandsen K, Colhoun HM, Deanfield J, Emerson SS, Esbjerg S, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221–2232. doi:10.1056/NEJMoa2307563 DOI: https://doi.org/10.1056/NEJMoa2307563

McGuire, Darren K et al. “Oral Semaglutide and Cardiovascular Outcomes in High-Risk Type 2 Diabetes.” The New England journal of medicine vol. 392,20 (2025): 2001-2012. doi:10.1056/NEJMoa2501006 DOI: https://doi.org/10.1056/NEJMoa2501006

Tardif JC, Kouz S, Waters DD, Bertrand OF, Diaz R, Maggioni AP, et al. Efficacy and safety of low-dose colchicine after myocardial infarction. N Engl J Med. 2019;381(26):2497–2505. doi:10.1056/NEJMoa1912388 DOI: https://doi.org/10.1056/NEJMoa1912388

Jolly SS, d’Entremont MA, Lee SF, Mian R, Tyrwhitt J, Kedev S, et al. Colchicine in acute myocardial infarction. N Engl J Med. 2025;392(7):633–642. doi:10.1056/NEJMoa2405922 DOI: https://doi.org/10.1056/NEJMoa2405922

Gibson CM, Bahit MC, Mehran R, Mehta SR, Lamee RA, Goto S, et al. Oral factor xia inhibitor milvexian after a recent acute coronary syndrome: rationale and design of the phase 3 (Librexia ACS). Am Heart J. 2025;285:21–28. doi:10.1016/j.ahj.2025.02.011 DOI: https://doi.org/10.1016/j.ahj.2025.02.011

Cho L, Nicholls SJ, Nordestgaard BG, Landmesser U, Tsimikas S, Blaha MJ, et al. Design and rationale of Lp(a)HORIZON trial: assessing the effect of lipoprotein(a) lowering with pelacarsen on major cardiovascular events in patients with CVD and elevated Lp(a). Am Heart J. 2025;287:1–9. doi:10.1016/j.ahj.2025.03.019 DOI: https://doi.org/10.1016/j.ahj.2025.03.019

Solomon SD, McMurray JJV, Vaduganathan M, Claggett B, Jhund PS, Desai AS, et al. Finerenone in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2024;391(16):1475–1485. doi:10.1056/NEJMoa2407107 DOI: https://doi.org/10.1056/NEJMe2410904

d’Aiello A, Filomia S, Brecciaroli M, Sanna T, Pedicino D, Liuzzo G. Targeting inflammatory pathways in atherosclerosis: exploring new opportunities for treatment. Curr Atheroscler Rep. 2024;26(12):707–719. doi:10.1007/s11883-024-01241-3 DOI: https://doi.org/10.1007/s11883-024-01241-3

Downloads

Published

2025-09-29

How to Cite

1.
Haddad K, Boivin-Proulx L-A, Mansour S. Secondary Prevention After Myocardial Infarction: Bridging Evidence to Practice. Can Cardiol Today [Internet]. 2025 Sep. 29 [cited 2025 Oct. 4];1(2):31–39. Available from: https://canadiancardiologytoday.com/article/view/1-2-Haddad_et_al

Issue

Section

Articles