View source for Unstable angina non ST elevation myocardial infarction primary prevention

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| [[Unstable angina/ NSTEMI resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{Unstable angina / NSTEMI}}
{{CMG}}; '''Associate Editors-In-Chief:''' {{CZ}}; [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.

==Overview==
The major risk factors for development of [[coronary heart disease]] have been established from several long term epidemiological studies.<ref name="pmid12485966">{{cite journal |author= |title=Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report |journal=[[Circulation]] |volume=106 |issue=25 |pages=3143–421 |year=2002 |month=December |pmid=12485966 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=12485966 |accessdate=2011-04-11}}</ref><ref name="pmid16461820">{{cite journal |author=Lloyd-Jones DM, Leip EP, Larson MG, D'Agostino RB, Beiser A, Wilson PW, Wolf PA, Levy D |title=Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age |journal=[[Circulation]] |volume=113 |issue=6 |pages=791–8 |year=2006 |month=February |pmid=16461820 |doi=10.1161/CIRCULATIONAHA.105.548206 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16461820 |accessdate=2011-04-11}}</ref> Various clinical trials have demonstrated that development of coronary disease, and the risk of developing unstable angina or NSTEMI in patients who have [[coronary heart disease]], can be lowered by modifying certain risk factors.<ref name="pmid10448784">{{cite journal |author=Ross SD, Allen IE, Connelly JE, Korenblat BM, Smith ME, Bishop D, Luo D |title=Clinical outcomes in statin treatment trials: a meta-analysis |journal=[[Archives of Internal Medicine]] |volume=159 |issue=15 |pages=1793–802 |year=1999 |pmid=10448784 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=10448784 |accessdate=2011-04-12}}</ref><ref name="pmid10761958">{{cite journal |author=Wilson K, Gibson N, Willan A, Cook D |title=Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies |journal=[[Archives of Internal Medicine]] |volume=160 |issue=7 |pages=939–44 |year=2000 |month=April |pmid=10761958 |doi= |url=http://archinte.ama-assn.org/cgi/pmidlookup?view=long&pmid=10761958 |accessdate=2011-04-12}}</ref><ref name="pmid11571256">{{cite journal |author=Smith SC, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, Fuster V, Gotto A, Grundy SM, Miller NH, Jacobs A, Jones D, Krauss RM, Mosca L, Ockene I, Pasternak RC, Pearson T, Pfeffer MA, Starke RD, Taubert KA |title=AHA/ACC Scientific Statement: AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology |journal=[[Circulation]] |volume=104 |issue=13 |pages=1577–9 |year=2001 |month=September |pmid=11571256 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11571256 |accessdate=2011-04-12}}</ref>

==Prevention Through the Assessment of Risk Factors==
The risk factors include:
*[[Smoking]]
*[[Obesity]] or being [[overweight]]
*An abnormal [[lipid profile]] 
*[[Diabetes mellitus]]
*Elevated [[blood pressure]]
*Sedentary lifestyle
*Advanced age
 
The 10 year risk of developing coronary heart disease can be assessed using a calculator based on the Framingham Heart Study<ref name="pmid11368702">{{cite journal |author= |title=Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III) |journal=[[JAMA : the Journal of the American Medical Association]] |volume=285 |issue=19 |pages=2486–97 |year=2001 |month=May |pmid=11368702 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=11368702 |accessdate=2011-04-12}}</ref> [https://www.americanheart.org/gglRisk/locale/en_US/index.html?gtype=health here].

Lifestyle changes can help prevent anginal attacks.Appropriate changes include:
*Weight loss in those who are [[overweight]] 
*[[Smoking]] cessation
*Strict control of [[blood pressure]], blood sugar in [[diabetes]], and [[cholesterol]] levels. Some studies have shown that making a few lifestyle changes can prevent blockages from progressing, and may actually reduce blockages.

==2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non -ST-Elevation Myocardial Infarction (DO NOT EDIT)<ref name="pmid21444888">{{cite journal| author=Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE et al.| title=2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 123 | issue= 18 | pages= e426-579 | pmid=21444888 | doi=10.1161/CIR.0b013e318212bb8b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21444888  }} </ref>==
===Identification of Patients at Risk (DO NOT EDIT)<ref name="pmid21444888">{{cite journal| author=Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE et al.| title=2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2011 | volume= 123 | issue= 18 | pages= e426-579 | pmid=21444888 | doi=10.1161/CIR.0b013e318212bb8b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21444888  }} </ref>===
{|class="wikitable"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Primary care providers should evaluate the presence and status of control of major risk factors for [[CHD]] for all patients at regular intervals (approximately every 3 to 5 years). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Ten-year risk (National Cholesterol Education Program [NCEP] global risk) of developing symptomatic [[CHD]] should be calculated for all patients who have 2 or more major risk factors to assess the need for primary prevention strategies.<ref name="pmid15249516">{{cite journal| author=Grundy SM, Cleeman JI, Merz CN, Brewer HB, Clark LT, Hunninghake DB et al.| title=Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. | journal=Circulation | year= 2004 | volume= 110 | issue= 2 | pages= 227-39 | pmid=15249516 | doi=10.1161/01.CIR.0000133317.49796.0E | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15249516  }} </ref><ref name="pmid12485966">{{cite journal| author=National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)| title=Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. | journal=Circulation | year= 2002 | volume= 106 | issue= 25 | pages= 3143-421 | pmid=12485966 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12485966  }} </ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Patients with established [[CHD]] should be identified for secondary prevention efforts, and patients with a CHD risk equivalent (e.g., [[atherosclerosis]] in other [[vascular bed]]s, [[diabetes mellitus]], [[chronic kidney disease]], or 10-year risk greater than 20% as calculated by Framingham equations) should receive equally intensive risk factor intervention as those with clinically apparent CHD. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki>
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==References==
{{Reflist|2}}
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