Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for lipid management: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
(/* ACC / AHA Guidelines - Lipid Management(DO NOT EDIT) {{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...)
No edit summary
Line 3: Line 3:
{{CMG}}; '''Associate Editors-in-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.
{{CMG}}; '''Associate Editors-in-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S.


==ACC / AHA Guidelines - Lipid Management(DO NOT EDIT) <ref name="pmid21444888">{{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 |title=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|journal=[[Circulation]] |volume= |issue= |pages= |year=2011 |month=March |pmid=21444888|doi=10.1161/CIR.0b013e318212bb8b |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=21444888 |accessdate=2011-04-08}}</ref><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>==
==ACC / AHA Guidelines - Lipid Management(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>==


{{cquote|
{|class="wikitable"
===[[ACC AHA guidelines classification scheme#Classification of Recommendation|Class I]]===
|-
 
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendation|Class I]]
'''1.''' The following lipid recommendations are beneficial:
|-
 
| bgcolor="LightGreen"|
::'''a.''' Lipid management should include assessment of a fasting lipid profile for all patients, within 24 h of hospitalization. ''(Level of Evidence: C)''
<nowiki>"</nowiki>'''1.''' The following lipid recommendations are beneficial:
::'''b.''' [[Hydroxymethyl glutaryl-coenzyme A reductase inhibitors]] ([[statins]]), in the absence of contraindications, regardless of baseline [[LDL-C]] and diet modification, should be given to post-[[UA]] / [[NSTEMI]] patients, including post revascularization patients. ''(Level of Evidence: A)''
::'''a.''' [[Hydroxymethyl glutaryl-coenzyme A reductase inhibitors]] ([[statins]]), in the absence of contraindications, regardless of baseline [[LDL-C]] and diet modification, should be given to post-[[UA]] / [[NSTEMI]] patients, including post revascularization patients. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level A]])''
::'''c.''' For hospitalized patients, lipid-lowering medications should be initiated before discharge. ''(Level of Evidence: A)''
::'''b.''' For [[UA]] / [[NSTEMI]] patients with elevated [[LDL-C]] (≥100 mg/dL), [[cholesterol]] lowering therapy should be initiated or intensified to achieve an [[LDL-C]] of <100 mg/dL. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level A]])'' Further titration to <70 mg/dL is reasonable ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level A]])''<nowiki>"</nowiki>
::'''d.''' For [[UA]] / [[NSTEMI]] patients with elevated [[LDL-C]] (≥100 mg/dL), [[cholesterol]] lowering therapy should be initiated or intensified to achieve an [[LDL-C]] of <100 mg/dL. ''(Level of Evidence: A)'' Further titration to <70 mg/dL is reasonable ''(Level of Evidence: A)''
|-
::'''e.''' Therapeutic options to reduce non [[HDL-C]] are recommended, including more intense [[LDL-C]] lowering therapy. ''(Level of Evidence: B)''
| bgcolor="LightGreen"|
::'''f.''' Dietary therapy for all patients should include reduced intake of [[saturated fat]]s (to <7% of total calories), [[cholesterol]] (to <200 mg/d), and trans fat (to <1% of energy). ''(Level of Evidence: B)''
|}
::'''g.''' Promoting daily physical activity and weight management are recommended. ''(Level of Evidence: B)''
 
'''2.''' Treatment of [[triglyceride]]s and [[non-HDL-C]] is useful, including the following:
 
::'''a.''' If [[triglyceride]]s are 200-499 mg/dL, [[non HDL-C]] should be <130 mg/dL. ''(Level of Evidence: B)''
::'''b.''' If [[triglyceride]]s are ≥500 mg/dL, therapeutic options to prevent [[pancreatitis]] are [[fibrate]] or [[niacin]] before [[LDL]]-lowering therapy is recommended. It is also recommended that [[LDL-C]] be treated to goal after [[triglyceride]] lowering therapy. Achievement of a [[non HDL-C]] <130 mg/dL (i.e., 30 mg/dL greater than [[LDL-C]] target) if possible is recommended. ''(Level of Evidence: C)''
 
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===
 
'''1.''' The following lipid management strategies can be beneficial:
 
::'''a.''' Further reduction of [[LDL-C]] to <70 mg/dL is reasonable. ''(Level of Evidence: A)''
::'''b.''' If baseline [[LDL cholesterol]] is 70-100 mg/dL, it is reasonable to treat [[LDL-C]] to less than 70 mg/dL. ''(Level of Evidence: B)''
::'''c.''' Further reduction of [[non HDL-C]] to <100 mg/dL is reasonable; if [[triglyceride]]s are 200 to 499 mg/dL, [[non HDL-C]] target is <130 mg/dL. ''(Level of Evidence: B)''
::'''d.''' Therapeutic options to reduce [[non-HDL-C]] (after [[LDL-C]] lowering) include [[niacin]] or [[fibrate]] therapy.
::'''e.''' [[Nicotinic acid]] ([[niacin]]) and fibric acid derivatives ([[fenofibrate]], [[gemfibrozil]]) can be useful as therapeutic options (after [[LDL-C]]– lowering therapy) for [[HDL-C]] <40 mg/dL. ''(Level of Evidence: B)''
::'''f.''' [[Nicotinic acid]] ([[niacin]]) and fibric acid derivatives ([[fenofibrate]], [[gemfibrozil]]) can be useful as therapeutic options (after [[LDL-C]] lowering therapy) for [[triglyceride]]s >200 mg/dL. ''(Level of Evidence: B)''
::'''g.''' The addition of plant stanol/sterols (2 g/day) and/or viscous fiber (>10 g/day) is reasonable to further lower [[LDL-C]]. ''(Level of Evidence: A)''
 
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===
 
'''1.''' Encouraging consumption of [[omega-3 fatty acids]] in the form of fish or in capsule form (1 g per d) for risk reduction may be reasonable. For treatment of elevated [[triglyceride]]s, higher doses (2 to 4 g per d) may be used for risk reduction. ''(Level of Evidence: B)''}}


==See Also==
==See Also==

Revision as of 02:56, 11 October 2012

Acute Coronary Syndrome Main Page

Unstable angina / NSTEMI Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Unstable Angina
Non-ST Elevation Myocardial Infarction

Differentiating Unstable Angina/Non-ST Elevation Myocardial Infarction from other Disorders

Epidemiology and Demographics

Risk Stratification

Natural History, Complications and Prognosis

Special Groups

Women
Heart Failure and Cardiogenic Shock
Perioperative NSTE-ACS Related to Noncardiac Surgery
Stress (Takotsubo) Cardiomyopathy
Diabetes Mellitus
Post CABG Patients
Older Adults
Chronic Kidney Disease
Angiographically Normal Coronary Arteries
Variant (Prinzmetal's) Angina
Substance Abuse
Cardiovascular "Syndrome X"

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Blood Studies
Biomarkers

Electrocardiogram

Chest X Ray

Echocardiography

Coronary Angiography

Treatment

Primary Prevention

Immediate Management

Anti-Ischemic and Analgesic Therapy

Cholesterol Management

Antitplatelet Therapy

Antiplatelet therapy recommendations
Aspirin
Thienopyridines
Glycoprotein IIb/IIIa Inhibitor

Anticoagulant Therapy

Additional Management Considerations for Antiplatelet and Anticoagulant Therapy

Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS

Mechanical Reperfusion

Initial Conservative Versus Initial Invasive Strategies
PCI
CABG

Complications of Bleeding and Transfusion

Discharge Care

Medical Regimen
Post-Discharge Follow-Up
Cardiac Rehabilitation

Long-Term Medical Therapy and Secondary Prevention

ICD implantation within 40 days of myocardial infarction

ICD within 90 days of revascularization

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for lipid management On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for lipid management

CDC onUnstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for lipid management

Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for lipid management in the news

Blogs on Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for lipid management

to Hospitals Treating Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for lipid management

Risk calculators and risk factors for Unstable angina non ST elevation myocardial infarction long-term medical therapy and secondary prevention ACC/AHA guidelines for lipid management

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-in-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

ACC / AHA Guidelines - Lipid Management(DO NOT EDIT) [1]

Class I

"1. The following lipid recommendations are beneficial:

a. Hydroxymethyl glutaryl-coenzyme A reductase inhibitors (statins), in the absence of contraindications, regardless of baseline LDL-C and diet modification, should be given to post-UA / NSTEMI patients, including post revascularization patients. (Level A)
b. For UA / NSTEMI patients with elevated LDL-C (≥100 mg/dL), cholesterol lowering therapy should be initiated or intensified to achieve an LDL-C of <100 mg/dL. (Level A) Further titration to <70 mg/dL is reasonable (Level A)"

See Also

Sources

References

  1. ↑ 1.0 1.1 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 (2007). "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 of the American College of Cardiology. 50 (7): e1–e157. doi:10.1016/j.jacc.2007.02.013. PMID 17692738. Retrieved 2011-04-11. Unknown parameter |month= ignored (help)
  2. ↑ Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE, Ettinger SM, Fesmire FM, Ganiats TG, Jneid H, Lincoff AM, Peterson ED, Philippides GJ, Theroux P, Wenger NK, Zidar JP (2011). "2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction (Updating the 2007 Guideline): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e31820f2f3e. PMID 21444889. Retrieved 2011-03-31. Unknown parameter |month= ignored (help)

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Unstable_angina_non_ST_elevation_myocardial_infarction_long-term_medical_therapy_and_secondary_prevention_ACC/AHA_guidelines_for_lipid_management&oldid=771537"