Coronary heart disease secondary prevention: Difference between revisions
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<nowiki>"</nowiki>'''1.''' Patients with established CHD should be identified for secondary prevention efforts, and patients with a CHD risk equivalent (e.g., atherosclerosis in other vascular beds, 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 A]])<nowiki>"</nowiki> | <nowiki>"</nowiki>'''1.''' Patients with established CHD should be identified for secondary prevention efforts, and patients with a CHD risk equivalent (e.g., atherosclerosis in other vascular beds, 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 A]])<nowiki>"</nowiki> | ||
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==Nitroglycerin Therapy== | |||
=== ACC / AHA 2007 Guidelines - Coronary Heart disease - Secondary Prevention with Nitroglycerin (DO NOT EDIT) <ref name="pmid17692738">{{cite journal|author=Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B |title=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/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine|journal=[[Journal of the American College of Cardiology]] |volume=50 |issue=7 |pages=e1–e157|year=2007 |month=August |pmid=17692738 |doi=10.1016/j.jacc.2007.02.013|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00511-6|accessdate=2011-04-11}}</ref>== | |||
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<nowiki>"</nowiki>'''1.''' [[Nitroglycerin]] to treat [[ischemic]] symptoms is recommended. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])''<nowiki>"</nowiki> | |||
===See Also=== | |||
* [[The Living Guidelines: UA/NSTEMI | The UA / NSTEMI Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]] | |||
===Sources=== | |||
*The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction <ref name="pmid17692738">{{cite journal|author=Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B |title=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/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine|journal=[[Journal of the American College of Cardiology]] |volume=50 |issue=7 |pages=e1–e157|year=2007 |month=August |pmid=17692738 |doi=10.1016/j.jacc.2007.02.013|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00511-6|accessdate=2011-04-12}}</ref> | |||
==Calcium Channel Blockers== | |||
===ACC / AHA 2007 Guidelines - Coronary Heart Disease - Secondary Prevention with Calcium Channel Blockers (DO NOT EDIT) <ref name="pmid17692738">{{cite journal|author=Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B |title=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/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine|journal=[[Journal of the American College of Cardiology]] |volume=50 |issue=7 |pages=e1–e157|year=2007 |month=August |pmid=17692738 |doi=10.1016/j.jacc.2007.02.013|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00511-6|accessdate=2011-04-11}}</ref>=== | |||
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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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<nowiki>"</nowiki>'''1.''' [[Calcium channel blocker]]s are recommended for ischemic symptoms when [[beta blocker]]s are not successful. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level B]])''<nowiki>"</nowiki> | |||
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<nowiki>"</nowiki>'''2.''' [[Calcium channel blocker]]s are recommended for ischemic symptoms when [[beta blocker]]s are contraindicated or cause unacceptable side effects. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level C]])''<nowiki>"</nowiki> | |||
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===See Also=== | |||
* [[The Living Guidelines: UA/NSTEMI | The UA / NSTEMI Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]] | |||
===Sources=== | |||
*The ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction <ref name="pmid17692738">{{cite journal |author=Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Ornato JP, Page RL, Riegel B |title=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/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine |journal=[[Journal of the American College of Cardiology]] |volume=50 |issue=7 |pages=e1–e157 |year=2007 |month=August |pmid=17692738 |doi=10.1016/j.jacc.2007.02.013 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)00511-6 |accessdate=2011-04-12}}</ref> | |||
== Smoking Cessation == | == Smoking Cessation == | ||
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=== Anti-platelet therapy === | === Anti-platelet therapy === | ||
A [[meta-analysis]] of [[randomized controlled trials]] by the international [[Cochrane Collaboration]] found "that the use of clopidogrel plus aspirin is associated with a reduction in the risk of cardiovascular events compared with aspirin alone in patients with acute non-ST coronary syndrome. In patients at high risk of cardiovascular disease but not presenting acutely, there is only weak evidence of benefit and hazards of treatment almost match any benefit obtained.".<ref name="pmid17636787">{{cite journal |author=Keller T, Squizzato A, Middeldorp S |title=Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular disease |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD005158 |year=2007 |pmid=17636787 |doi=10.1002/14651858.CD005158.pub2}}</ref> | A [[meta-analysis]] of [[randomized controlled trials]] by the international [[Cochrane Collaboration]] found "that the use of clopidogrel plus aspirin is associated with a reduction in the risk of cardiovascular events compared with aspirin alone in patients with acute non-ST coronary syndrome. In patients at high risk of cardiovascular disease but not presenting acutely, there is only weak evidence of benefit and hazards of treatment almost match any benefit obtained.".<ref name="pmid17636787">{{cite journal |author=Keller T, Squizzato A, Middeldorp S |title=Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular disease |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD005158 |year=2007 |pmid=17636787 |doi=10.1002/14651858.CD005158.pub2}}</ref> | ||
== References == | == References == | ||
{{Reflist|2}} | {{Reflist|2}} |
Revision as of 19:04, 10 October 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Patients who should be treated with secondary prevention are those with established atherosclerosis including peripheral artery disease; carotid artery disease; atherosclerotic aortic disease; diabetes and those with a Framingham Risk Score of > 20%. There are 10 aspects of secondary prevention: Smoking cessation; blood pressure control; lipid-lowering; increasing physical activity; weight loss; diabetes control; antiplatelet agents/anticoagulants; RAS blockers; beta-blockers and influenza vaccine.
Target Population
Patients who should be treated with secondary prevention are those with established atherosclerosis including peripheral artery disease; carotid artery disease; atherosclerotic aortic disease; diabetes and those with a Framingham Risk Score of > 20%.
ACC / AHA 2012 Guidelines - Coronary Heart Disease - Identification of Patients at Risk for Coronary Heart Disease[1] (DO NOT EDIT)
Class I |
"1. Patients with established CHD should be identified for secondary prevention efforts, and patients with a CHD risk equivalent (e.g., atherosclerosis in other vascular beds, 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. (Level A)" |
Nitroglycerin Therapy
= ACC / AHA 2007 Guidelines - Coronary Heart disease - Secondary Prevention with Nitroglycerin (DO NOT EDIT) [2]
Class I | |||||||||||||||||||||||||||||||||||||||||||
"1. Nitroglycerin to treat ischemic symptoms is recommended. (Level C)" See AlsoSources
Calcium Channel BlockersACC / AHA 2007 Guidelines - Coronary Heart Disease - Secondary Prevention with Calcium Channel Blockers (DO NOT EDIT) [2]
See AlsoSources
Smoking CessationAHA / ACC 2006 Guidelines - Coronary Heart disease - Secondary Prevention for Patients With Coronary and Other Vascular Disease (DO NOT EDIT)Goal: Complete Cessation. No Exposure to environmental tobacco smoke.
Blood Pressure Control
Initiate or maintain lifestyle modification (weight control, EtOH moderation, sodium reduction, increased physical activity, increased fruits, vegetables, low-fat dairy)
AHA/ACC Secondary Prevention for Patients With Coronary and Other Vascular Disease : 2006 Update (DO NOT EDIT)Goal: <140/90 mm Hg or <130/80 mm Hg if patient has diabetes or chronic kidney disease. For all Patients:
For patients with blood pressure ≥140/90 mm Hg (or ≥130/80 mm Hg for individuals with chronic kidney disease or diabetes):
Lipid ManagementAHA/ACC Secondary Prevention for Patients With Coronary and Other Vascular Disease : 2006 Update (DO NOT EDIT)Goal: LDL-C <100 mg/dL; If triglycerides are ≥200 mg/dL, non-HDL-C should be <130 mg/dL. For all patients:
For lipid management:Assess fasting lipid profile in all patients, and within 24 hours of hospitalization for those with an acute cardiovascular or coronary event. For hospitalized patients, initiate lipid-lowering medication as recommended below before discharge according to the following schedule:
Physical Activity Recommendations
AHA/ACC Secondary Prevention for Patients With Coronary and Other Vascular Disease : 2006 Update (DO NOT EDIT)Goal: 30 minutes, 7 days per week (minimum 5 days per week)
Weight Management
AHA/ACC Secondary Prevention for Patients With Coronary and Other Vascular Disease : 2006 Update (DO NOT EDIT)Goal: Body mass index: 18.5 to 24.9 kg/m2; Waist circumference: men <40 inches, women <35 inches
ACE Inhibition
Angiotensin Receptor Blockade
Diabetes Mellitus
Anti-platelet therapyA meta-analysis of randomized controlled trials by the international Cochrane Collaboration found "that the use of clopidogrel plus aspirin is associated with a reduction in the risk of cardiovascular events compared with aspirin alone in patients with acute non-ST coronary syndrome. In patients at high risk of cardiovascular disease but not presenting acutely, there is only weak evidence of benefit and hazards of treatment almost match any benefit obtained.".[3] References
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