Coronary heart disease secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Physical Activity Recommendations

Encourage 30 to 60 minutes of moderate intensity aerobic activity such as brisk walking, on most, preferably all, days of the week. Advise medically supervised programs for high-risk patients (e.g. recent acute coronary syndrome or revascularization, heart failure)

Weight Management

• Goal: BMI 18.5 to 24.9 kg/m2
• Waist Circumference:

• Men: < 40 inches
• Women: < 35 inches

• If waist circumference >35 inches in women and >40 inches in men initiate lifestyle changes and consider treatment strategies for metabolic syndrome as indicated.
• The initial goal of weight loss therapy should be to reduce body weight by approximately 5-10 percent from baseline.

ACE Inhibition

• Use in all patients with LVEF < 40%, and those with diabetes or chronic kidney disease indefinitely, unless contraindicated
• Consider for all other patients

Angiotensin Receptor Blockade

• Use in patients who are intolerant of ACE inhibitors with heart failure or post MI with LVEF less than or equal to 40%.
• Consider in other patients who are ACE inhibitor intolerant.

Diabetes Mellitus

• Lifestyle and pharmacotherapy to achieve HbA1C <7% may be considered.
• Less stringent goal for may be considered (severe hypoglycemia, limited life expectancy, extensive comorbidities)

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.".