Chronic stable angina pharmacotherapy to prevent MI and death in asymptomatic patients

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Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Cafer Zorkun, M.D., Ph.D. [2]; Associate Editors-In-Chief: John Fani Srour, M.D.; Jinhui Wu, MD; Aysha Aslam, M.B.B.S[3]

2014 Focused update of 2012 ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)[1][2][3]

Pharmacotherapy to Prevent MI and Death in Asymptomatic Patients (DO NOT EDIT)[1][2][3]

Class I
"1. Treatment with aspirin 75 to 162 mg daily should be continued indefinitely in the absence of contraindications in patients with SIHD. (Level of Evidence: A)"
"2. Treatment with clopidogrel is reasonable when aspirin is contraindicated in patients with SIHD(Level of Evidence: B)"
"3. Beta-blocker therapy should be started and continued for 3 years in all patients with normal LV function after MI or ACS(Level of Evidence: B)"
"4. Beta-blocker therapy should be used in all patients with LV systolic dysfunction (ejection fraction (≤40%) with heart failure or prior MI, unless contraindicated. (Use should be limited to carvedilol, metoprolol succinate, or bisoprolol, which have been shown to reduce risk of death.) (Level of Evidence: A)"
"5. ACE inhibitors should be prescribed in all patients with SIHD who also have hypertension, diabetes mellitus, LV ejection fraction 40% or less, or chronic kidney disease, unless contraindicated (Level of Evidence: A)"
"5. An annual influenza vaccine is recommended for patients with SIHD (Level of Evidence: B)"
Class IIa
"1. Treatment with an ACE inhibitor is reasonable in patients with both SIHD and other vascular disease (Level of Evidence: B)"
"2. It is reasonable to use angiotensin-receptor blockers in other patients who are ACE inhibitor intolerant (Level of Evidence: C)"
Class IIb
"1. Treatment with aspirin 75 to 162 mg daily and clopidogrel 75 mg daily might be reasonable in certain high-risk patients with SIHD (Level of Evidence: B)"
"2. Beta blockers may be considered as chronic therapy for all other patients with coronary or other vascular disease. (Level of Evidence: C)"
"3. The usefulness of chelation therapy is uncertain for reducing cardiovascular events in patients with SIHD. (Level of Evidence: C)"
Class III
"1. Dipyridamole is not recommended as antiplatelet therapy for patients with SIHD. (Level of Evidence: B)"
"2. Estrogen therapy is not recommended in postmenopausal women with SIHD with the intent of reducing cardiovascular risk or improving clinical outcomes. (Level of Evidence: A)"
"3. Vitamin C, vitamin E, and beta-carotene supplementation are not recommended with the intent of reducing cardiovascular risk or improving clinical outcomes in patients with SIHD. (Level of Evidence: A)"
"4. Treatment of elevated homocysteine with folate or vitamins B6 and B12 is not recommended with the intent of reducing cardiovascular risk or improving clinical outcomes in patients with SIHD (Level of Evidence: A)"
"5. Treatment with garlic, coenzyme Q10, selenium, or chromium is not recommended with the intent of reducing cardiovascular risk or improving clinical outcomes in patients with SIHD (Level of Evidence: C)"

References

  1. 1.0 1.1 Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ; et al. (2014). "2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 64 (18): 1929–49. doi:10.1016/j.jacc.2014.07.017. PMID 25077860.
  2. 2.0 2.1 Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP; et al. (2012). "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 126 (25): 3097–137. doi:10.1161/CIR.0b013e3182776f83. PMID 23166210.
  3. 3.0 3.1 Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS; et al. (2003). "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)". J Am Coll Cardiol. 41 (1): 159–68. PMID 12570960.

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