Coronary heart disease secondary prevention: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(76 intermediate revisions by 5 users not shown)
Line 3: Line 3:
{{CMG}}
{{CMG}}


==Overview==
== Overview ==
Patients who should be treated with secondary prevention are those with established atherosclerosis including peripheral artery
disease; carotid artery disease; atherosclerotic aortic disease; diabetes and those with a Framingham Risk Score of > 20%.
There are 10 aspects of secondary prevention: Smoking cessation; blood pressure control; lipid-lowering; increasing physical activity; weight loss; diabetes control;  antiplatelet agents/anticoagulants; RAS blockers; beta-blockers and influenza vaccine.


==Target Population==
Patients who should be treated with secondary prevention are those with established atherosclerosis including peripheral artery
Patients who should be treated with secondary prevention are those with established atherosclerosis including peripheral artery
disease; carotid artery disease; atherosclerotic aortic disease; diabetes and those with a Framingham Risk Score of > 20%.
disease; carotid artery disease; atherosclerotic aortic disease; diabetes and those with a Framingham Risk Score of > 20%.
There are 12 aspects of secondary prevention: Smoking cessation; blood pressure control; lipid-lowering; increasing physical activity; weight loss; diabetes control;  antiplatelet agents/anticoagulants; RAS blockers; beta-blockers; depression management; cardiac rehabilitation and influenza vaccine. Please note that secondary prevention guidelines, especially, those involving medication, may differ between [[Unstable Angina|UA/NSTEMI]]; [[STEMI]]; and [[Chronic Stable Angina]]. Please refer to appropriate page for more specific guidelines.


==Smoking Cessation==
==[[Coronary heart disease secondary prevention target population | Target Population]]==
===AHA/ACC Secondary Prevention for Patients With Coronary and Other Vascular Disease : 2006 Update===
==[[Coronary heart disease secondary prevention patient education | Patient Education]]==
{{cquote|
==[[Coronary heart disease secondary prevention smoking cessation | Smoking Cessation]]==
==[[Coronary heart disease secondary prevention blood pressure control | Blood Pressure Control]]==
==[[Coronary heart disease secondary prevention lipid management | Lipid Management]]==
==[[Coronary heart disease secondary prevention physical activity recommendations | Physical Activity Recommendations]]==
==[[Coronary heart disease secondary prevention weight management | Weight Management]]==
==[[Coronary heart disease secondary prevention influenza vaccination | Influenza Vaccination]]==
==[[Coronary heart disease secondary prevention depression | Depression]]==
==[[Coronary heart disease secondary prevention beta-blockers | Beta Blockers]]==
==[[Coronary heart disease secondary prevention diabetes mellitus management | Diabete Mellitus Management]]==
==[[Coronary heart disease secondary prevention antiplatelet agents/anticoagulants | Antiplatelet Agents/Anticoagulants]]==


'''Goal:''' Complete Cessation. No Exposure to environmental tobacco smoke.
==[[Coronary heart disease secondary prevention renin-angiotensin-aldosterone system blockers |Renin-angiotensin-aldosterone system blockers]]==
 
==[[Coronary heart disease secondary prevention cardiac rehabilitation | Cardiac Rehabilitation]]==
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.''' Ask about tobacco use status at every visit. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])
 
'''2.''' Advise every tobacco user to quit. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])
 
'''3.''' Assess the tobacco user's willingness to quit. [[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])
 
'''4.''' Assist counseling and developing a plan for quitting. [[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])
 
'''5.''' Arrange follow-up, referral to special programs, or pharmacotherapy (including nicotine replacement and bupropion). [[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])
 
'''6.''' Urge avoidance of exposure to environmental tobacco smoke at work and home. [[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])


==References==
{{reflist|2}}


}}
[[Category:Cardiology]]
[[Category:Disease]]


==Blood Pressure Control==
{{WH}}
*If blood pressure is > 120/80 mm Hg:
{{WS}}
Initiate or maintain lifestyle modification (weight control, EtOH moderation, sodium reduction, increased physical activity, increased fruits, vegetables, low-fat dairy)
*If blood pressure > 140/90 mm Hg: As tolerated, add blood pressure medication (betablockers and/or ACE inhibitors initially).
 
===AHA/ACC Secondary Prevention for Patients With Coronary and Other Vascular Disease : 2006 Update===
 
For all patients:
 
==Lipid Management==
*Assess fasting lipid profile in all patients with CHD, and within 24 hours of an acute cardiovascular or coronary event.
*For hospitalized patients, initiate lipid-lowering medication before discharge.
*LDL-C should be less than 100 mg/dL AND at least a 30% reduction in LDL.
*Further reduction to LDL-C to < 70 mg/dL in very high risk patients is reasonable
*If TG >200 mg/dL, non-HDL-C should be < 130 mg/dL
*Start dietary therapy (<7% of total calories as saturated fat and <200 mg/d cholesterol)
*Add plant stanol/sterols (2 gm/day) and viscous fiber (>10 mg/day)
*Promote daily physical activity and weight management.
*Omega-3 fatty acids in fish or 1 g/day
*Omega-3 fatty acids in capsule form.
 
==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.".<ref name="pmid17636787">{{cite journal |author=Keller T, Squizzato A, Middeldorp S |title=Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular disease |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD005158 |year=2007 |pmid=17636787 |doi=10.1002/14651858.CD005158.pub2}}</ref>
 
==References==
{{Reflist|2}}

Latest revision as of 20:53, 8 January 2013

Coronary heart disease Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Differentiating Coronary heart disease from other Diseases

Epidemiology and Demographics

Risk Factors

Screening and Risk Stratification

Natural History, Complications and Prognosis

Diagnosis

Pretest Probability

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Coronary heart disease secondary prevention On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Coronary heart disease secondary prevention

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Coronary heart disease secondary prevention

CDC on Coronary heart disease secondary prevention

Coronary heart disease secondary prevention in the news

Blogs on Coronary heart disease secondary prevention

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Coronary heart disease secondary prevention

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

Overview

Patients who should be treated with secondary prevention are those with established atherosclerosis including peripheral artery disease; carotid artery disease; atherosclerotic aortic disease; diabetes and those with a Framingham Risk Score of > 20%. There are 12 aspects of secondary prevention: Smoking cessation; blood pressure control; lipid-lowering; increasing physical activity; weight loss; diabetes control; antiplatelet agents/anticoagulants; RAS blockers; beta-blockers; depression management; cardiac rehabilitation and influenza vaccine. Please note that secondary prevention guidelines, especially, those involving medication, may differ between UA/NSTEMI; STEMI; and Chronic Stable Angina. Please refer to appropriate page for more specific guidelines.

Target Population

Patient Education

Smoking Cessation

Blood Pressure Control

Lipid Management

Physical Activity Recommendations

Weight Management

Influenza Vaccination

Depression

Beta Blockers

Diabete Mellitus Management

Antiplatelet Agents/Anticoagulants

Renin-angiotensin-aldosterone system blockers

Cardiac Rehabilitation

References

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Coronary_heart_disease_secondary_prevention&oldid=827632"