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'''Associate Editor-In-Chief:''' {{CZ}}
'''Editor-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' [[Lakshmi Gopalakrishnan, M.B.B.S.]]


{{EH}}
==Overview==
In patients with [[Chronic stable angina definition|chronic stable angina]], initiation of intensive risk factor modification remains an urgent and essential part of secondary prevention strategy, as they directly influence the [[Chronic stable angina prognosis|prognosis]]. Based on the 27th Bethesda Conference, [[coronary heart disease risk factors|risk factor]] modification is divided into four categories according to both the strength of evidence for causation and the evidence that risk factor modification established significant reduction in the occurrence of future coronary events.<ref name="pmid8609364">Pasternak RC, Grundy SM, Levy D, Thompson PD (1996) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8609364 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 3. Spectrum of risk factors for coronary heart disease.] ''J Am Coll Cardiol'' 27 (5):978-90. PMID: [http://pubmed.gov/8609364 8609364]</ref> ACC/AHA states that Identifying and, when present, treating [[Coronary heart disease risk factors|Category I]] risk factors can be an optimal secondary prevention strategy in patients with chronic stable angina.<ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref> You can read more about general coronary heart disease secondary prevention, [[Coronary heart disease secondary prevention|here]].


==Prevention of Chronic Stable Angina==
==Individual Topics for Secondary Prevention==
 
You can read in greater detail about each of the risk factor modification topic below by clicking on the link for that topic:
Patients are increasingly and rightly demanding accessible and readily understandable information which enables them to be full partners in management decisions about their conditions.
*'''[[Chronic stable angina treatment smoking cessation|Smoking Cessation]]'''
 
*'''[[Chronic stable angina treatment weight management|Weight Management]]'''
As well as the world leading organizations such as the American Heart Association, the European Society of Cardiology, the World Heart Federation and the British Heart Foundation; the WikiDoc Foundation, a non for profit organization have produced many helpful chapters explaining heart disease, its primary and secondary prevention, treatment and rehabilitation, and for many patients this is understandable and sufficient.
*'''[[Chronic stable angina treatment physical activity|Physical Activity]]'''
 
*'''[[Chronic stable angina treatment lipid management|Lipid Management]]'''
==ACC / AHA Guidelines- Treatment of Risk Factors (DO NOT EDIT)<ref name="Gibbons1"> Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP–ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). Circulation. 1999; 99: 2829–2848. PMID 10351980</ref>==
*'''[[Chronic stable angina treatment blood pressure control|BP Control]]'''
{{cquote|
*'''[[Chronic stable angina treatment diabetes control|Diabetes Control]]'''
===Class I===
*'''[[Chronic stable angina treatment psychological factors|Management of psychological factors]]'''
1. Treatment of [[hypertension]] according to Joint National Conference VI guidelines. ''(Level of Evidence: A)''
*'''[[Chronic stable angina treatment alcohal consumption|Alcohal consumption]]'''
 
*'''[[Chronic stable angina treatment avoidance of air pollution|Avoidance of air pollution]]'''
2. [[Smoking cessation therapy]]. ''(Level of Evidence: B)''
*'''[[Chronic stable angina treatment additional therapy to reduce risk of MI and death|Additional therapy to reduce risk of MI and death]]'''
 
*'''[[Chronic stable angina treatment influenza vaccination|Influneza Vaccination]]'''
3. Management of [[diabetes]]. ''(Level of Evidence: C)''
 
4. Exercise training program. ''(Level of Evidence: B)''
 
5. Lipid-lowering therapy in patients with documented or suspected [[CAD]] and [[LDL]] >130 mg/dL, with a target [[LDL]] <100 mg/dL. ''(Level of Evidence: A)''
 
6. Weight reduction in [[obese]] patients in the presence of [[hypertension]], [[hyperlipidemia]], or [[diabetes mellitus]]. ''(Level of Evidence: C)''
 
===Class IIa===
1. Lipid-lowering therapy in patients with documented or suspected [[CAD]] and [[LDL cholesterol]] 100 to 129 mg/dL, with a target [[LDL]] of <100 mg/dL. ''(Level of Evidence: B)''
 
===Class IIb===
1. [[Hormonal replacement therapy]] in postmenopausal women in the absence of contraindications. ''(Level of Evidence: B)''
 
2. Weight reduction in [[obese]] patients in the absence of [[hypertension]], [[hyperlipidemia]], or [[diabetes mellitus]]. ''(Level of Evidence: C)''
 
3. [[Folate therapy]] in patients with elevated [[homocysteine]] levels. ''(Level of Evidence: C)''
 
4. [[Vitamin C]] and [[Vitamin E|E]] supplementation. ''(Level of Evidence: B)''
 
5. Identification and appropriate treatment of [[clinical depression]]. ''(Level of Evidence: C)''
 
6. Intervention directed at psychosocial [[stress]] reduction. ''(Level of Evidence: C)''
 
===Class III===
1. [[Chelation therapy]]. ''(Level of Evidence: C)''
 
2. [[Garlic]]. ''(Level of Evidence: C)''
 
3. [[Acupuncture]]. ''(Level of Evidence: C)''}}
 
==See Also==
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
 
==Sources==
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="Gibbons1"> Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP–ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). Circulation. 1999; 99: 2829–2848. PMID 10351980</ref>
 
*TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="Gibbons2">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr, Fihn SD, Fraker TD Jr, Gardin JM, O'Rourke RA, Pasternak RC, Williams SV, Gibbons RJ, Alpert JS, Antman EM, Hiratzka LF, Fuster V, Faxon DP, Gregoratos G, Jacobs AK, Smith SC Jr; American College of Cardiology; American Heart Association Task Force on Practice Guidelines. Committee on the Management of Patients With Chronic Stable Angina. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation. 2003 Jan 7; 107 (1): 149-58. PMID 12515758 </ref>
 
*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="Fraker"> Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr, Gardin JM, O'Rourke RA, Williams SV, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW; American College of Cardiology; American Heart Association; American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007 Dec 4; 116 (23): 2762-72. Epub 2007 Nov 12. PMID 17998462 </ref>


==References==
==References==
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Latest revision as of 18:16, 31 October 2016

Chronic stable angina Microchapters

Acute Coronary Syndrome Main Page

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Patient Information

Overview

Historical Perspective

Classification

Classic
Chronic Stable Angina
Atypical
Walk through Angina
Mixed Angina
Nocturnal Angina
Postprandial Angina
Cardiac Syndrome X
Vasospastic Angina

Differentiating Chronic Stable Angina from Acute Coronary Syndromes

Pathophysiology

Epidemiology and Demographics

Risk Stratification

Pretest Probability of CAD in a Patient with Angina

Prognosis

Diagnosis

History and Symptoms

Physical Examination

Test Selection Guideline for the Individual Basis

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Electrocardiogram

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Treatment

Medical Therapy

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Alternative Therapies for Refractory Angina

Transmyocardial Revascularization (TMR)
Spinal Cord Stimulation (SCS)
Enhanced External Counter Pulsation (EECP)
ACC/AHA Guidelines for Alternative Therapies in patients with Refractory Angina

Discharge Care

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Secondary Prevention

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Noninvasive Testing in Asymptomatic Patients
Risk Stratification by Coronary Angiography
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Risk calculators and risk factors for Chronic stable angina secondary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Phone:617-632-7753; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.

Overview

In patients with chronic stable angina, initiation of intensive risk factor modification remains an urgent and essential part of secondary prevention strategy, as they directly influence the prognosis. Based on the 27th Bethesda Conference, risk factor modification is divided into four categories according to both the strength of evidence for causation and the evidence that risk factor modification established significant reduction in the occurrence of future coronary events.[1] ACC/AHA states that Identifying and, when present, treating Category I risk factors can be an optimal secondary prevention strategy in patients with chronic stable angina.[2] You can read more about general coronary heart disease secondary prevention, here.

Individual Topics for Secondary Prevention

You can read in greater detail about each of the risk factor modification topic below by clicking on the link for that topic:

References

  1. ↑ Pasternak RC, Grundy SM, Levy D, Thompson PD (1996) 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 3. Spectrum of risk factors for coronary heart disease. J Am Coll Cardiol 27 (5):978-90. PMID: 8609364
  2. ↑ Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58.[1] PMID: 12515758

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