Unstable angina non ST elevation myocardial infarction primary prevention
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Resident Survival Guide |
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Unstable angina / NSTEMI Microchapters |
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Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders |
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Special Groups |
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Diagnosis |
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Laboratory Findings |
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Treatment |
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Antitplatelet Therapy |
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Additional Management Considerations for Antiplatelet and Anticoagulant Therapy |
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Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS |
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Mechanical Reperfusion |
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Discharge Care |
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Case Studies |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; 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.[1][2] 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.[3][4][5]
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[6] 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)[7]
Identification of Patients at Risk (DO NOT EDIT)[7]
| Class I |
| "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). (Level of Evidence: C)" |
| "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.[8][1] (Level of Evidence: B)" |
| "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 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 of Evidence: A)" |
References
- ↑ 1.0 1.1 "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". Circulation. 106 (25): 3143–421. 2002. PMID 12485966. Retrieved 2011-04-11. Unknown parameter
|month=ignored (help) - ↑ Lloyd-Jones DM, Leip EP, Larson MG, D'Agostino RB, Beiser A, Wilson PW, Wolf PA, Levy D (2006). "Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age". Circulation. 113 (6): 791–8. doi:10.1161/CIRCULATIONAHA.105.548206. PMID 16461820. Retrieved 2011-04-11. Unknown parameter
|month=ignored (help) - ↑ Ross SD, Allen IE, Connelly JE, Korenblat BM, Smith ME, Bishop D, Luo D (1999). "Clinical outcomes in statin treatment trials: a meta-analysis". Archives of Internal Medicine. 159 (15): 1793–802. PMID 10448784. Retrieved 2011-04-12.
- ↑ Wilson K, Gibson N, Willan A, Cook D (2000). "Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies". Archives of Internal Medicine. 160 (7): 939–44. PMID 10761958. Retrieved 2011-04-12. Unknown parameter
|month=ignored (help) - ↑ 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 (2001). "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". Circulation. 104 (13): 1577–9. PMID 11571256. Retrieved 2011-04-12. Unknown parameter
|month=ignored (help) - ↑ "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)". JAMA : the Journal of the American Medical Association. 285 (19): 2486–97. 2001. PMID 11368702. Retrieved 2011-04-12. Unknown parameter
|month=ignored (help) - ↑ 7.0 7.1 Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE; et al. (2011). "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". Circulation. 123 (18): e426–579. doi:10.1161/CIR.0b013e318212bb8b. PMID 21444888.
- ↑ Grundy SM, Cleeman JI, Merz CN, Brewer HB, Clark LT, Hunninghake DB; et al. (2004). "Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines". Circulation. 110 (2): 227–39. doi:10.1161/01.CIR.0000133317.49796.0E. PMID 15249516.