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| {{SI}}
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| {{WikiDoc Cardiology Network Infobox}}
| | {{Chronic stable angina}} |
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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.]] |
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| {{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]]. |
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| ==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><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>==
| | *'''[[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]] 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)''
| | *'''[[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)''
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| 4. Exercise training program. ''(Level of Evidence: B)''
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| 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)''
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| 6. Weight reduction in [[obese]] patients in the presence of [[hypertension]], [[hyperlipidemia]], or [[diabetes mellitus]]. ''(Level of Evidence: C)''
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| ===Class IIa===
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| 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)''
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| :a. Lifestyle and/or drug therapies to lower [[LDL]] to less than 100 mg/dL. ''(Level of Evidence: B)''
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| :b. Weight reduction and increased physical activity in persons with the metabolic syndrome. ''(Level of
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| Evidence: B)''
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| :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)''
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| 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)''
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| 4. Weight reduction in [[obese]] patients in the absence of [[hypertension]], [[hyperlipidemia]], or [[diabetes mellitus]]. ''(Level of Evidence: C)''
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| ===Class IIb===
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| 1. [[Folate therapy]] in patients with elevated [[homocysteine]] levels. ''(Level of Evidence: C)''
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| 2. Identification and appropriate treatment of [[clinical depression]]. ''(Level of Evidence: C)''
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| 3. Intervention directed at psychosocial [[stress]] reduction. ''(Level of Evidence: C)''
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| ===Class III===
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| 1. [[Chelation therapy]]. ''(Level of Evidence: C)''
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| 2. [[Garlic]]. ''(Level of Evidence: C)''
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| 3. [[Acupuncture]]. ''(Level of Evidence: C)''
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| 4. Initiation of [[hormone replacement therapy]] ([[HRT]]) in postmenopausal women for the purpose of reducing cardiovascular risk. ''(Level of Evidence: A)''
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| 5. [[Vitamin C]] and [[Vitamin E|E]] supplementation. ''(Level of Evidence: A)''
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| 6. [[Coenzyme Q]]. ''(Level of Evidence: C)''}}
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| ==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>==
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| ===Class I===
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| 1. [[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)''
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| 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)''
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| 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)''
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| 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)''
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| ===Class IIa===
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| 1. 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)''
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| ===Class IIb===
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| 1. [[Angiotensin receptor blockers]] may be considered in combination with [[ACE inhibitors]] for [[heart failure]] due to [[left ventricular systolic dysfunction]]. ''(Level of Evidence: B)''}}
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| ==See Also==
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| *[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
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| ==Sources==
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| *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>
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| *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>
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| *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>
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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