Chronic stable angina treatment smoking cessation: Difference between revisions

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(/* 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT) Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused u...)
(/* Smoking Cessation (DO NOT EDIT){{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic hea...)
 
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The 1989 Surgeon General’s report, which assessed numerous case-control and cohort studies, reported that smoking increased cardiovascular disease mortality by 50%.<ref name="pmid2494426">Centers for Disease Control (CDC) (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2494426 The Surgeon General's 1989 Report on Reducing the Health Consequences of Smoking: 25 Years of Progress.] ''MMWR Morb Mortal Wkly Rep'' 38 Suppl 2 ():1-32. PMID: [http://pubmed.gov/2494426 2494426]</ref> Cigarette smoking, likely due to the hemodynamic consequences of sympathetic neural stimulation and systemic [[catecholamine]] release, plays an important role in the pathogenesis of [[coronary artery disease]]. Cigarette smoking also forms a major risk factor for acute cardiovascular events as it relates to an associated increase in [[Coagulopathy|blood coagulability]].<ref name="pmid9180099">Benowitz NL, Gourlay SG (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9180099 Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy.] ''J Am Coll Cardiol'' 29 (7):1422-31. PMID: [http://pubmed.gov/9180099 9180099]</ref> Hence, cigarette smoking is an important reversible risk factor in the pathogenesis of [[CAD]] and cessation of which improves [[Chronic stable angina prognosis|prognosis]] and is associated with a substantial decrease in the risk of mortality.<ref name="pmid8114863">Bartecchi CE, MacKenzie TD, Schrier RW (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8114863 The human costs of tobacco use (1)] ''N Engl J Med'' 330 (13):907-12. [http://dx.doi.org/10.1056/NEJM199403313301307 DOI:10.1056/NEJM199403313301307] PMID: [http://pubmed.gov/8114863 8114863]</ref><ref name="pmid8121461">MacKenzie TD, Bartecchi CE, Schrier RW (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8121461 The human costs of tobacco use (2)] ''N Engl J Med'' 330 (14):975-80. [http://dx.doi.org/10.1056/NEJM199404073301406 DOI:10.1056/NEJM199404073301406] PMID: [http://pubmed.gov/8121461 8121461]</ref><ref name="pmid14583958">Critchley J, Capewell S (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14583958 Smoking cessation for the secondary prevention of coronary heart disease.] ''Cochrane Database Syst Rev''  (4):CD003041. [http://dx.doi.org/10.1002/14651858.CD003041 DOI:10.1002/14651858.CD003041] PMID: [http://pubmed.gov/14583958 14583958]</ref> In patients with [[Chronic stable angina definition|stable angina pectoris]], nicotine replacement therapy has shown to be potentially beneficial despite the associated cardiovascular risks of [[nicotine]], such as increase in [[heart rate]] with a small rise in [[blood pressure]]. Nicotine replacement therapy may be initiated as early as 2–3 days after [[MI|acute myocardial infarction]] or [[arrhythmias|cardiac arrhythmias]].<ref name="pmid9180099">Benowitz NL, Gourlay SG (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9180099 Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy.] ''J Am Coll Cardiol'' 29 (7):1422-31. PMID: [http://pubmed.gov/9180099 9180099]</ref>  Additionally, nicotine patches have been used successfully in [[Chronic stable angina risk assessment in patients with an intermediate or high probability of coronary artery disease|high-risk patients]] without any adverse effects such as aggravation of [[MI]] or [[arrhythmia]].<ref name="pmid9784902">Tzivoni D, Keren A, Meyler S, Khoury Z, Lerer T, Brunel P (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9784902 Cardiovascular safety of transdermal nicotine patches in patients with coronary artery disease who try to quit smoking.] ''Cardiovasc Drugs Ther'' 12 (3):239-44. PMID: [http://pubmed.gov/9784902 9784902]</ref><ref name="pmid8179456"> (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8179456 Nicotine replacement therapy for patients with coronary artery disease. Working Group for the Study of Transdermal Nicotine in Patients with Coronary artery disease.] ''Arch Intern Med'' 154 (9):989-95. PMID: [http://pubmed.gov/8179456 8179456]</ref>
The 1989 Surgeon General’s report, which assessed numerous case-control and cohort studies, reported that smoking increased cardiovascular disease mortality by 50%.<ref name="pmid2494426">Centers for Disease Control (CDC) (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2494426 The Surgeon General's 1989 Report on Reducing the Health Consequences of Smoking: 25 Years of Progress.] ''MMWR Morb Mortal Wkly Rep'' 38 Suppl 2 ():1-32. PMID: [http://pubmed.gov/2494426 2494426]</ref> Cigarette smoking, likely due to the hemodynamic consequences of sympathetic neural stimulation and systemic [[catecholamine]] release, plays an important role in the pathogenesis of [[coronary artery disease]]. Cigarette smoking also forms a major risk factor for acute cardiovascular events as it relates to an associated increase in [[Coagulopathy|blood coagulability]].<ref name="pmid9180099">Benowitz NL, Gourlay SG (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9180099 Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy.] ''J Am Coll Cardiol'' 29 (7):1422-31. PMID: [http://pubmed.gov/9180099 9180099]</ref> Hence, cigarette smoking is an important reversible risk factor in the pathogenesis of [[CAD]] and cessation of which improves [[Chronic stable angina prognosis|prognosis]] and is associated with a substantial decrease in the risk of mortality.<ref name="pmid8114863">Bartecchi CE, MacKenzie TD, Schrier RW (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8114863 The human costs of tobacco use (1)] ''N Engl J Med'' 330 (13):907-12. [http://dx.doi.org/10.1056/NEJM199403313301307 DOI:10.1056/NEJM199403313301307] PMID: [http://pubmed.gov/8114863 8114863]</ref><ref name="pmid8121461">MacKenzie TD, Bartecchi CE, Schrier RW (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8121461 The human costs of tobacco use (2)] ''N Engl J Med'' 330 (14):975-80. [http://dx.doi.org/10.1056/NEJM199404073301406 DOI:10.1056/NEJM199404073301406] PMID: [http://pubmed.gov/8121461 8121461]</ref><ref name="pmid14583958">Critchley J, Capewell S (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14583958 Smoking cessation for the secondary prevention of coronary heart disease.] ''Cochrane Database Syst Rev''  (4):CD003041. [http://dx.doi.org/10.1002/14651858.CD003041 DOI:10.1002/14651858.CD003041] PMID: [http://pubmed.gov/14583958 14583958]</ref> In patients with [[Chronic stable angina definition|stable angina pectoris]], nicotine replacement therapy has shown to be potentially beneficial despite the associated cardiovascular risks of [[nicotine]], such as increase in [[heart rate]] with a small rise in [[blood pressure]]. Nicotine replacement therapy may be initiated as early as 2–3 days after [[MI|acute myocardial infarction]] or [[arrhythmias|cardiac arrhythmias]].<ref name="pmid9180099">Benowitz NL, Gourlay SG (1997) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9180099 Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy.] ''J Am Coll Cardiol'' 29 (7):1422-31. PMID: [http://pubmed.gov/9180099 9180099]</ref>  Additionally, nicotine patches have been used successfully in [[Chronic stable angina risk assessment in patients with an intermediate or high probability of coronary artery disease|high-risk patients]] without any adverse effects such as aggravation of [[MI]] or [[arrhythmia]].<ref name="pmid9784902">Tzivoni D, Keren A, Meyler S, Khoury Z, Lerer T, Brunel P (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9784902 Cardiovascular safety of transdermal nicotine patches in patients with coronary artery disease who try to quit smoking.] ''Cardiovasc Drugs Ther'' 12 (3):239-44. PMID: [http://pubmed.gov/9784902 9784902]</ref><ref name="pmid8179456"> (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8179456 Nicotine replacement therapy for patients with coronary artery disease. Working Group for the Study of Transdermal Nicotine in Patients with Coronary artery disease.] ''Arch Intern Med'' 154 (9):989-95. PMID: [http://pubmed.gov/8179456 8179456]</ref>


==Smoking Cessation: The 5A Step-wise Strategy==
==Smoking Cessation==
*A: Ask Systematic identification of all smokers at every opportunity.  
===The 5A Step-wise Strategy===
*A: Ask systematic identification of all smokers at every opportunity.  


*A: Assess Determine the patient’s degree of addiction and his/her willingness to stop smoking.
*A: Assess determine the patient’s degree of addiction and his/her willingness to stop smoking.


*A: Advise Strongly encourage all smokers to quit smoking.
*A: Advise strongly encourage all smokers to quit smoking.


*A: Assist Provide a smoking cessation strategy that includes behavioral counseling, nicotine replacement therapy and/or pharmacological intervention.
*A: Assist provide a smoking cessation strategy that includes behavioral counseling, nicotine replacement therapy and/or pharmacological intervention.


*A: Arrange Offer help to schedule follow-up visits.
*A: Arrange offer help to schedule follow-up visits.


==Supportive Trial Data==
===Supportive Trial Data===
*The ''Cochrane database'', a meta-analysis of 20 studies that aimed to estimate the magnitude of risk reduction associated with smoking cessation, reported that there was a 36% reduction in the overall mortality (crude RR 0.64, 95% CI 0.58 to 0.71) and a significant reduction in the rate of [[MI|non-fatal MI]] (crude RR 0.68, 95% CI 0.57 to 0.82).<ref name="pmid14583958">Critchley J, Capewell S (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14583958 Smoking cessation for the secondary prevention of coronary heart disease.] ''Cochrane Database Syst Rev''  (4):CD003041. [http://dx.doi.org/10.1002/14651858.CD003041 DOI:10.1002/14651858.CD003041] PMID: [http://pubmed.gov/14583958 14583958]</ref>
*The ''Cochrane database'', a meta-analysis of 20 studies that aimed to estimate the magnitude of risk reduction associated with smoking cessation, reported that there was a 36% reduction in the overall mortality (crude RR 0.64, 95% CI 0.58 to 0.71) and a significant reduction in the rate of [[MI|non-fatal MI]] (crude RR 0.68, 95% CI 0.57 to 0.82).<ref name="pmid14583958">Critchley J, Capewell S (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14583958 Smoking cessation for the secondary prevention of coronary heart disease.] ''Cochrane Database Syst Rev''  (4):CD003041. [http://dx.doi.org/10.1002/14651858.CD003041 DOI:10.1002/14651858.CD003041] PMID: [http://pubmed.gov/14583958 14583958]</ref>


*Based on a placebo-controlled, randomized study that assessed the cardiovascular safety of [[nicotine|nicotine patches]] in patients with [[coronary artery disease]] who tried to quit smoking, there were no observed changes in the [[heart rate|resting heart rate]] and [[blood pressure]] between the screening and follow-up phases. There were also no significant changes observed in the number and duration of ischemic episodes or in the frequency of [[arrhythmias]]. However, exercise tolerance and time to 1-mm [[ST segment depression]] increased in both groups. Thus, the study concluded the use of [[nicotine|nicotine patches]] to promote smoking cessation was safe in patients with [[Chronic stable angina risk assessment in patients with an intermediate or high probability of coronary artery disease|high-risk]] for [[CAD]].<ref name="pmid9784902">Tzivoni D, Keren A, Meyler S, Khoury Z, Lerer T, Brunel P (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9784902 Cardiovascular safety of transdermal nicotine patches in patients with coronary artery disease who try to quit smoking.] ''Cardiovasc Drugs Ther'' 12 (3):239-44. PMID: [http://pubmed.gov/9784902 9784902]</ref> Similar results were observed in another study that assessed the safety of [[nicotine|transdermal nicotine]] for smoking cessation in patients with [[coronary artery disease]].<ref name="pmid8179456"> (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8179456 Nicotine replacement therapy for patients with coronary artery disease. Working Group for the Study of Transdermal Nicotine in Patients with Coronary artery disease.] ''Arch Intern Med'' 154 (9):989-95. PMID: [http://pubmed.gov/8179456 8179456]</ref>
*Based on a placebo-controlled, randomized study that assessed the cardiovascular safety of [[nicotine|nicotine patches]] in patients with [[coronary artery disease]] who tried to quit smoking, there were no observed changes in the [[heart rate|resting heart rate]] and [[blood pressure]] between the screening and follow-up phases. There were also no significant changes observed in the number and duration of ischemic episodes or in the frequency of [[arrhythmias]]. However, exercise tolerance and time to 1-mm [[ST segment depression]] increased in both groups. Thus, the study concluded the use of [[nicotine|nicotine patches]] to promote smoking cessation was safe in patients with [[Chronic stable angina risk assessment in patients with an intermediate or high probability of coronary artery disease|high-risk]] for [[CAD]].<ref name="pmid9784902">Tzivoni D, Keren A, Meyler S, Khoury Z, Lerer T, Brunel P (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9784902 Cardiovascular safety of transdermal nicotine patches in patients with coronary artery disease who try to quit smoking.] ''Cardiovasc Drugs Ther'' 12 (3):239-44. PMID: [http://pubmed.gov/9784902 9784902]</ref> Similar results were observed in another study that assessed the safety of [[nicotine|transdermal nicotine]] for smoking cessation in patients with [[coronary artery disease]].<ref name="pmid8179456"> (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8179456 Nicotine replacement therapy for patients with coronary artery disease. Working Group for the Study of Transdermal Nicotine in Patients with Coronary artery disease.] ''Arch Intern Med'' 154 (9):989-95. PMID: [http://pubmed.gov/8179456 8179456]</ref>


==2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)<ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 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).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref>==
==2012 Chronic Angina Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)<ref name="pmid23166210">{{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=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. | journal=Circulation | year= 2012 | volume= 126 | issue= 25 | pages= 3097-137 | pmid=23166210 | doi=10.1161/CIR.0b013e3182776f83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23166210  }} </ref><ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 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).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref>==


===Smoking Cessation (DO NOT EDIT)<ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 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).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref>===
===Smoking Cessation (DO NOT EDIT)<ref name="pmid23166210">{{cite journal| author=Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP et al.| title=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. | journal=Circulation | year= 2012 | volume= 126 | issue= 25 | pages= 3097-137 | pmid=23166210 | doi=10.1161/CIR.0b013e3182776f83 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23166210  }} </ref>===


{|class="wikitable"
{|class="wikitable"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Smoking cessation and avoidance of exposure to environmental tobacco smoke at work and home is recommended. Follow-up, referral to special programs, and/or pharmacotherapy (including [[nicotine|nicotine replacement]]) is recommended, as is a stepwise strategy for smoking cessation (Ask, Advise, Assess, Assist, Arrange). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Smoking cessation and avoidance of exposure to environmental tobacco smoke at work and home should be encouraged for all patients with SIHD. Follow-up, referral to special programs, and pharmacotherapy are recommended, as is a stepwise strategy for smoking cessation (Ask, Advise, Assess, Assist, Arrange, Avoid). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
|}
==Related Chapters==
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
==Sources==
*[http://circ.ahajournals.org/content/99/21/2829.full.pdf The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina]<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref>
*[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf The ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina]<ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 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).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref>
*[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina]<ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref>
*[http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology]<ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf]}} </ref>


==References==
==References==
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Latest revision as of 16:25, 31 October 2016

Chronic stable angina Microchapters

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Overview

Historical Perspective

Classification

Classic
Chronic Stable Angina
Atypical
Walk through Angina
Mixed Angina
Nocturnal Angina
Postprandial Angina
Cardiac Syndrome X
Vasospastic Angina

Differentiating Chronic Stable Angina from Acute Coronary Syndromes

Pathophysiology

Epidemiology and Demographics

Risk Stratification

Pretest Probability of CAD in a Patient with Angina

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Treatment

Medical Therapy

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Alternative Therapies for Refractory Angina

Transmyocardial Revascularization (TMR)
Spinal Cord Stimulation (SCS)
Enhanced External Counter Pulsation (EECP)
ACC/AHA Guidelines for Alternative Therapies in patients with Refractory Angina

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Guidelines for Asymptomatic Patients

Noninvasive Testing in Asymptomatic Patients
Risk Stratification by Coronary Angiography
Pharmacotherapy to Prevent MI and Death in Asymptomatic Patients

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Case #1

Chronic stable angina treatment smoking cessation On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Phone:617-632-7753; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan. M.B.B.S.

Overview

The 1989 Surgeon General’s report, which assessed numerous case-control and cohort studies, reported that smoking increased cardiovascular disease mortality by 50%.[1] Cigarette smoking, likely due to the hemodynamic consequences of sympathetic neural stimulation and systemic catecholamine release, plays an important role in the pathogenesis of coronary artery disease. Cigarette smoking also forms a major risk factor for acute cardiovascular events as it relates to an associated increase in blood coagulability.[2] Hence, cigarette smoking is an important reversible risk factor in the pathogenesis of CAD and cessation of which improves prognosis and is associated with a substantial decrease in the risk of mortality.[3][4][5] In patients with stable angina pectoris, nicotine replacement therapy has shown to be potentially beneficial despite the associated cardiovascular risks of nicotine, such as increase in heart rate with a small rise in blood pressure. Nicotine replacement therapy may be initiated as early as 2–3 days after acute myocardial infarction or cardiac arrhythmias.[2] Additionally, nicotine patches have been used successfully in high-risk patients without any adverse effects such as aggravation of MI or arrhythmia.[6][7]

Smoking Cessation

The 5A Step-wise Strategy

  • A: Ask systematic identification of all smokers at every opportunity.
  • A: Assess determine the patient’s degree of addiction and his/her willingness to stop smoking.
  • A: Advise strongly encourage all smokers to quit smoking.
  • A: Assist provide a smoking cessation strategy that includes behavioral counseling, nicotine replacement therapy and/or pharmacological intervention.
  • A: Arrange offer help to schedule follow-up visits.

Supportive Trial Data

  • The Cochrane database, a meta-analysis of 20 studies that aimed to estimate the magnitude of risk reduction associated with smoking cessation, reported that there was a 36% reduction in the overall mortality (crude RR 0.64, 95% CI 0.58 to 0.71) and a significant reduction in the rate of non-fatal MI (crude RR 0.68, 95% CI 0.57 to 0.82).[5]

2012 Chronic Angina Guidelines for the Management of Patients With Chronic Stable Angina (DO NOT EDIT)[8][9][10]

Smoking Cessation (DO NOT EDIT)[8]

Class I
"1. Smoking cessation and avoidance of exposure to environmental tobacco smoke at work and home should be encouraged for all patients with SIHD. Follow-up, referral to special programs, and pharmacotherapy are recommended, as is a stepwise strategy for smoking cessation (Ask, Advise, Assess, Assist, Arrange, Avoid). (Level of Evidence: B) "

References

  1. ↑ Centers for Disease Control (CDC) (1989) The Surgeon General's 1989 Report on Reducing the Health Consequences of Smoking: 25 Years of Progress. MMWR Morb Mortal Wkly Rep 38 Suppl 2 ():1-32. PMID: 2494426
  2. ↑ 2.0 2.1 Benowitz NL, Gourlay SG (1997) Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy. J Am Coll Cardiol 29 (7):1422-31. PMID: 9180099
  3. ↑ Bartecchi CE, MacKenzie TD, Schrier RW (1994) The human costs of tobacco use (1) N Engl J Med 330 (13):907-12. DOI:10.1056/NEJM199403313301307 PMID: 8114863
  4. ↑ MacKenzie TD, Bartecchi CE, Schrier RW (1994) The human costs of tobacco use (2) N Engl J Med 330 (14):975-80. DOI:10.1056/NEJM199404073301406 PMID: 8121461
  5. ↑ 5.0 5.1 Critchley J, Capewell S (2003) Smoking cessation for the secondary prevention of coronary heart disease. Cochrane Database Syst Rev (4):CD003041. DOI:10.1002/14651858.CD003041 PMID: 14583958
  6. ↑ 6.0 6.1 Tzivoni D, Keren A, Meyler S, Khoury Z, Lerer T, Brunel P (1998) Cardiovascular safety of transdermal nicotine patches in patients with coronary artery disease who try to quit smoking. Cardiovasc Drugs Ther 12 (3):239-44. PMID: 9784902
  7. ↑ 7.0 7.1 (1994) Nicotine replacement therapy for patients with coronary artery disease. Working Group for the Study of Transdermal Nicotine in Patients with Coronary artery disease. Arch Intern Med 154 (9):989-95. PMID: 8179456
  8. ↑ 8.0 8.1 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.
  9. ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72.[1] PMID: 17998462
  10. ↑ 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). Circulation 107 (1):149-58.[2] PMID: 12515758

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