Proton pump inhibitors decrease the risk of gastrointesti- nal bleeding in patients treated with DAPT431 and are used in patients treated with DAPT who have a history of gastrointes- tinal bleeding and those at increased risk of bleeding, which is associated with oral anticoagulation therapy even if there is no history of gastrointestinal bleeding.430 On the basis of these results, proton pump inhibitors are also used in patients receiving triple antithrombotic therapy who have a history of gastrointestinal bleeding. Although the clinical evidence that omeprazole and esomeprazole diminish the antiplate- let efficacy of clopidogrel is weak,430 the US Food and Drug Administration has issued a warning to avoid concomitant use of these 2 proton pump inhibitors with clopidogrel.442 6.2.3. Platelet Function and Genetic Phenotype Testing Although higher platelet reactivity has been associated with a greater incidence of adverse events in patients undergoing stent implantation, a strategy of adjusting antiplatelet therapy based on routine platelet function testing has not been ben- eficial in reducing ischemic complications.26,443 445 Similarly, a strategy of routine genetic phenotype testing has also not been beneficial and thus is not recommended.26,446 448 A more detailed discussion of these issues and current recommenda- tions about platelet function testing and genetic testing are in 6.3. Risk Reduction Strategies for Secondary Prevention Secondary prevention is a critical aspect of the management of care for the survivor of NSTE-ACS. It has been clearly estab- lished that in this high-risk cohort, subsequent cardiovascular morbidity and mortality can be reduced by a comprehensive approach to favorably modifying patients risk profiles.27 Secondary prevention comprises lifestyle changes, risk fac- tor education, medical therapy, and, where appropriate, revas- cularization. These elements are discussed in Section 6.4. 