A 67-Year-Old Patient With Stable ASCVD
A 67-year-old male patient with history of coronary artery disease with prior percutaneous coronary intervention (PCI) of the mid left anterior descending artery in March 2020, hypertension, hyperlipidemia, type 2 diabetes mellitus, and chronic kidney disease stage 2 presents to his primary cardiologist for follow-up. His current medications include aspirin 81 mg daily, atorvastatin 80 mg daily, lisinopril 10 mg daily, metoprolol succinate 25 mg daily, and metformin 500 mg daily.
In early 2020, he presented to the emergency department with chest pain at rest. His physical exam was unremarkable; however, he was found to have ST depression in V2-V4 on his electrocardiogram and an elevated high-sensitivity troponin. He was taken to the cardiac catherization laboratory where coronary angiography revealed severe stenosis of his mid left anterior descending artery. He underwent PCI with placement of a drug-eluting stent. Subsequently, he was chest-pain free and discharged from the hospital the next day. Echocardiography during the hospitalization revealed no major abnormalities in ventricular function and preserved ejection fraction. He completed a 12-month course of dual antiplatelet therapy with a P2Y12 receptor inhibitor, ticagrelor, and aspirin 81 mg with no complications. Afterwards, ticagrelor was discontinued, and he remained on aspirin monotherapy.
Now in clinic, he reports that since discontinuing the ticagrelor, he has remained free of chest pain and is able to complete his daily activities without limitation. He is adherent to all his prescribed medications and purchases his aspirin over the counter at the local drugstore. On examination, his heart rate is 67 bpm, and blood pressure is 115/72 mmHg. The remainder of the exam is unremarkable. At the end of the clinic visit, the patient asks if he should switch to high-dose 325 mg aspirin given his recent heart attack.
What is the most appropriate recommendation for this patient?