Chronic stable angina secondary prevention: Difference between revisions
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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. | 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. | ||
==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>== | ==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><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>== | ||
{{cquote| | {{cquote| | ||
===Class I=== | ===Class I=== | ||
1. Treatment of [[hypertension]] according to Joint National Conference VI guidelines. ''(Level of Evidence: A)'' | 1. Treatment of [[hypertension]] according to Joint National Conference VI guidelines. ''(Level of Evidence: A)'' | ||
2. [[Smoking cessation | 2. [[Smoking cessation]] and avoidance of exposure to environmental [[tobacco]] smoke at work and home is recommended. Follow-up, referral to special programs, and/or pharmacotherapy (including [[nicotine replacement]]) is recommended, as is a stepwise strategy for [[smoking cessation]] (Ask, Advise, Assess, Assist, Arrange). ''(Level of Evidence: B)'' | ||
3. Management of [[diabetes]]. ''(Level of Evidence: C)'' | 3. Management of [[diabetes]]. ''(Level of Evidence: C)'' | ||
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===Class IIa=== | ===Class IIa=== | ||
1. | 1. In patients with documented or suspected [[CAD]] and [[low-density lipoprotein cholesterol|low-density lipoprotein]] ([[LDL]]) [[cholesterol]] 100 to 129 mg/dL, several therapeutic options are available: ''(Level of Evidence: B)'' | ||
:a. Lifestyle and/or drug therapies to lower [[LDL]] to less than 100 mg/dL. ''(Level of Evidence: B)'' | |||
:b. Weight reduction and increased physical activity in persons with the metabolic syndrome. ''(Level of | |||
Evidence: B)'' | |||
:c. Institution of treatment of other [[lipid]] or nonlipid risk factors; consider use of [[nicotinic acid]] or [[fibric acid]] for elevated [[triglyceride]]s or low [[highdensity lipoprotein cholesterol|highdensity lipoprotein]] ([[HDL]]) [[cholesterol]]. ''(Level of Evidence: B)'' | |||
3. Therapy to lower non-[[HDL cholesterol]] in patients with documented or suspected [[CAD]] and [[triglyceride]] levels greater than 200 mg/dL, with a target non-[[HDL cholesterol]] level of less than 130 mg/dL. ''(Level of Evidence: B)'' | |||
4. Weight reduction in [[obese]] patients in the absence of [[hypertension]], [[hyperlipidemia]], or [[diabetes mellitus]]. ''(Level of Evidence: C)'' | |||
===Class IIb=== | |||
1. [[Folate therapy]] in patients with elevated [[homocysteine]] levels. ''(Level of Evidence: C)'' | |||
2. Identification and appropriate treatment of [[clinical depression]]. ''(Level of Evidence: C)'' | |||
3. Intervention directed at psychosocial [[stress]] reduction. ''(Level of Evidence: C)'' | |||
===Class III=== | ===Class III=== | ||
| Line 49: | Line 51: | ||
2. [[Garlic]]. ''(Level of Evidence: C)'' | 2. [[Garlic]]. ''(Level of Evidence: C)'' | ||
3. [[Acupuncture]]. ''(Level of Evidence: C)''}} | 3. [[Acupuncture]]. ''(Level of Evidence: C)'' | ||
4. Initiation of [[hormone replacement therapy]] ([[HRT]]) in postmenopausal women for the purpose of reducing cardiovascular risk. ''(Level of Evidence: A)'' | |||
5. [[Vitamin C]] and [[VitaminE|E]] supplementation. ''(Level of Evidence: A)'' | |||
6. [[Coenzyme Q]]. ''(Level of Evidence: C)''}} | |||
==ACC / AHA Guidelines- Renin-Angiotensin-Aldosterone System Blockers (DO NOT EDIT)<ref name=" | ==ACC / AHA Guidelines- Renin-Angiotensin-Aldosterone System Blockers (DO NOT EDIT)<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>== | ||
{{cquote| | {{cquote| | ||
===Class I=== | ===Class I=== | ||
Revision as of 19:04, 4 June 2009
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Prevention of Chronic Stable Angina
Patients are increasingly and rightly demanding accessible and readily understandable information which enables them to be full partners in management decisions about their conditions.
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.
ACC / AHA Guidelines- Treatment of Risk Factors (DO NOT EDIT)[1][2]
| “ |
Class I1. Treatment of hypertension according to Joint National Conference VI guidelines. (Level of Evidence: A) 2. Smoking cessation and avoidance of exposure to environmental tobacco smoke at work and home is recommended. Follow-up, referral to special programs, and/or pharmacotherapy (including nicotine replacement) is recommended, as is a stepwise strategy for smoking cessation (Ask, Advise, Assess, Assist, Arrange). (Level of Evidence: B) 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 IIa1. In patients with documented or suspected CAD and low-density lipoprotein (LDL) cholesterol 100 to 129 mg/dL, several therapeutic options are available: (Level of Evidence: B)
Evidence: B)
3. Therapy to lower non-HDL cholesterol in patients with documented or suspected CAD and triglyceride levels greater than 200 mg/dL, with a target non-HDL cholesterol level of less than 130 mg/dL. (Level of Evidence: B) 4. Weight reduction in obese patients in the absence of hypertension, hyperlipidemia, or diabetes mellitus. (Level of Evidence: C) Class IIb1. Folate therapy in patients with elevated homocysteine levels. (Level of Evidence: C) 2. Identification and appropriate treatment of clinical depression. (Level of Evidence: C) 3. Intervention directed at psychosocial stress reduction. (Level of Evidence: C) Class III1. Chelation therapy. (Level of Evidence: C) 2. Garlic. (Level of Evidence: C) 3. Acupuncture. (Level of Evidence: C) 4. Initiation of hormone replacement therapy (HRT) in postmenopausal women for the purpose of reducing cardiovascular risk. (Level of Evidence: A) 5. Vitamin C and E supplementation. (Level of Evidence: A) 6. Coenzyme Q. (Level of Evidence: C) |
” |
ACC / AHA Guidelines- Renin-Angiotensin-Aldosterone System Blockers (DO NOT EDIT)[3]
| “ |
Class I1. ACE inhibitors should be started and continued indefinitely in all patients with left ventricular ejection fraction less than or equal to 40% and in those with hypertension, diabetes, or chronic kidney disease unless contraindicated. (Level of Evidence: A) 2. ACE inhibitors should be started and continued indefinitely in patients who are not lower risk (lower risk defined as those with normal left ventricular ejection fraction in whom cardiovascular risk factors are well controlled and revascularization has been performed), unless contraindicated. (Level of Evidence: B) 3. Angiotensin receptor blockers are recommended for patients who have hypertension, have indications for but are intolerant of ACE inhibitors, have heart failure, or have had a myocardial infarction with left ventricular ejection fraction less than or equal to 40%. (Level of Evidence: A) 4. Aldosterone blockade is recommended for use in post-MI patients without significant renal dysfunction or hyperkalemia who are already receiving therapeutic doses of an ACE inhibitor and a beta blocker, have a left ventricular ejection fraction less than or equal to 40%, and have either diabetes or heart failure. (Level of Evidence: A) Class IIa1. It is reasonable to use ACE inhibitors among lower-risk patients with mildly reduced or normal left ventricular ejection fraction in whom cardiovascular risk factors are well controlled and revascularization has been performed. (Level of Evidence: B) Class IIb1. Angiotensin receptor blockers may be considered in combination with ACE inhibitors for heart failure due to left ventricular systolic dysfunction. (Level of Evidence: B) |
” |
See Also
Sources
- The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [1]
- TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [2]
- The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [3]
References
- ↑ 1.0 1.1 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
- ↑ 2.0 2.1 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
- ↑ 3.0 3.1 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