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Optimal Management of Stable CAD Patients

Learn about the comprehensive guidelines for diagnosing and managing stable ischemic heart disease. Discover the key medical therapies, lifestyle interventions, and preventive measures to relieve symptoms, prevent heart attacks, and promote cardiac health. Understand the role of beta-blockers, aspirin, renin-angiotensin-aldosterone system blockers, and explore non-US available antianginal agents like ivabradine and nicorandil. Discover important recommendations for optimal patient care based on the latest research and evidence.

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Optimal Management of Stable CAD Patients

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  1. AHA 2012 American Guidelines for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease Keypoints Fihn SD, Gardin JM, Abrams J, et al; American College of Cardiology Foundation/American Heart Association Task Force. Circulation. 2012;726(25):e354-e471. doi: 10.1161/CIR.0b013e318277d6a0.

  2. Medical therapy for relief of symptoms Class I, Level of evidence: B Class I, Level of evidence: B Class IIa, Level of evidence: B/A Add/substitute ranolazine Fihn SD, Gardin JM, Abrams J, et al; American College of Cardiology Foundation/American Heart Association Task Force. Circulation. 2012;726(25):e354-e471. doi:10.1161/CIR.0b013e318277d6a0.

  3. Medical therapy for relief of symptoms • The management of stable CAD starts with lifestyle intervention. • Medical therapy is the first-line treatment for patients with stable CAD. • -Blockers are recommended as the initial treatment for relief of symptoms in patients with stable CAD. • If symptoms persist after medical therapy, physicians are advised to consider coronary artery revascularization. Fihn SD, Gardin JM, Abrams J, et al; American College of Cardiology Foundation/American Heart Association Task Force. Circulation. 2012;726(25):e354-e471. doi:10.1161/CIR.0b013e318277d6a0.

  4. Therapy to prevent MI and death • Aspirin(class I, level of evidence: A) • -Blockers • For 3 years, in patients with normal LV function after MI or ACS • (class I, level of evidence: B). • In patients with LV systolic dysfunction (ejection fraction <40%) with heart failure or prior MI, unless contraindicated (carvedilol, metoprolol succinate, or bisoprolol) (class I, level of evidence: A). • For all other patients,-blockers are recommended (class IIb, level of evidence: C). • Renin-angiotensin-aldosterone system blockers • In patients with HT, diabetes mellitus, LV ejection fraction ≤40%, or chronic kidney disease, unless contraindicated(class I, level of evidence: A) or in patients with CAD and other vascular disease (class I, level of evidence: B). • ARBs are recommended in case of intolerability of ACE inhibitors(level of evidence: A). Fihn SD, Gardin JM, Abrams J, et al; American College of Cardiology Foundation/American Heart Association Task Force. Circulation. 2012;726(25):e354-e471. doi:10.1161/CIR.0b013e318277d6a0.

  5. Antianginal agents not available in the United States • Ivabradine, nicorandil, trimetazidine. • In regard to trimetazidine, guidelines highlight: • The metabolic mode of action. • The clinical efficacy on ischemia and angina. • The anti-ischemic effects not associated with changes in heart rate or systolic blood pressure. • The data on cardiovascular end points, mortality, and quality of life. • The good tolerability. => Trimetazidine is not available in the United States, but is available in Europe and in more than 80 countries worldwide. Fihn SD, Gardin JM, Abrams J, et al; American College of Cardiology Foundation/American Heart Association Task Force. Circulation. 2012;726(25):e354-e471. doi:10.1161/CIR.0b013e318277d6a0.

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