Chronic stable angina treatment additional therapy to reduce risk of MI and death
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
2012 Chronic Angina Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)[1]
Additional therapy to prevent MI and death
Antiplatelet therapy
| Class I |
| "1. Treatment with aspirin 75 to 162 mg daily should be continued indefinitely in the absence of contraindications in patients with SIHD"(Level of Evidence:A ) " |
| "2. Treatment with clopidogrel is reasonable when aspirin is contraindicated in patients with SIHD"(Level of Evidence: ) " |
| Class IIb |
| "1. Treatment with aspirin 75 to 162 mg daily and clopidogrel 75 mg daily might be reasonable in certain high-risk patients with SIHD"(Level of Evidence:B ) " |
| Class III |
| "1. Dipyridamole is not recommended as antiplatelet therapy for patients with SIHD"(Level of Evidence:B) " |
Beta Blocker therapy
| Class I |
| "1. Beta-blocker therapy should be started and continued for 3 years in all patients with normal LV function after MI or ACS"(Level of Evidence:B ) " |
| "2. Beta-blocker therapy should be used in all patients with LV systolic dysfunction (ejection fraction 40%) with heart failure or prior MI, unless contraindicated. (Use should be limited to carvedilol, metoprolol succinate, or bisoprolol, which have been shown to reduce risk of death.)"(Level of Evidence: A ) " |
| Class IIb |
| "1. Beta blockers may be considered as chronic therapy for all other patients with coronary or other vascular disease"(Level of Evidence:C) " |
Renin Angiotensin Aldosterone blocker therapy
| Class I |
| "1. ACE inhibitors should be prescribed in all patients with SIHD who also have hypertension, diabetes mellitus, LV ejection fraction 40% or less, or chronic kidney disease, unless contraindicated"(Level of Evidence:A ) " |
| "2. Angiotensin-receptor blockers are recommended for patients with SIHD who have hypertension, diabetes mellitus, LV systolic dysfunction, or chronic kidney disease and have indications for, but are intolerant of, ACE inhibitors"(Level of Evidence:A ) " |
| Class IIa |
| "1. Treatment with an ACE inhibitor is reasonable in patients with both SIHD and other vascular disease ("(Level of Evidence:B) " |
| "2. It is reasonable to use angiotensin-receptor blockers in other patients who are ACE inhibitor intolerant"(Level of Evidence:C) " |
Influenza vaccination
| Class I |
| "1. An annual influenza vaccine is recommended for patients with SIHD."(Level of Evidence:B ) " |
Additional therapy to reduce risk of MI and death
| Class III |
| "1. Estrogen therapy is not recommended in postmenopausal women with SIHD with the intent of reducing cardiovascular risk or improving clinical outcomes"(Level of Evidence:A ) " |
| "2. Vitamin C, vitamin E, and beta-carotene supplementation are not recommended with the intent of reducing cardiovascular risk or improving clinical outcomes in patients with SIHD"(Level of Evidence:A ) " |
| "3. Treatment of elevated homocysteine with folate or vitamins B6 and B12 is not recommended with the intent of reducing cardiovascular risk or improving clinical outcomes in patients with SIHD"(Level of Evidence:A ) " |
| "4. Chelation therapy is not recommended with the intent of improving symptoms or reducing cardiovascular risk in patients with SIHD"(Level of Evidence:C ) " |
| "5. Treatment with garlic, coenzyme Q10, selenium, or chromium is not recommended with the intent of reducing cardiovascular risk or improving clinical outcomes in patients with SIHD"(Level of Evidence:C) " |
References
- ↑ Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP; et al. (2012). "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 126 (25): 3097–137. doi:10.1161/CIR.0b013e3182776f83. PMID 23166210.