Coronary heart disease secondary prevention: Difference between revisions
(Created page with "__NOTOC__ {{Coronary heart disease}} {{CMG}} ==Overview== ==Secondary prevention== Secondary prevention is preventing further sequelae of already established disease. Regard...") |
No edit summary |
||
| Line 7: | Line 7: | ||
==Secondary prevention== | ==Secondary prevention== | ||
Secondary prevention is preventing further sequelae of already established disease. Regarding coronary heart disease, this can mean risk factor management that is carried out during cardiac rehabilitation, a 4-phase process beginning in hospital after MI, angioplasty or heart surgery and continuing for a minimum of three months. Exercise is a main component of cardiac rehabilitation along with diet, smoking cessation, and blood pressure and cholesterol management. | Secondary prevention is preventing further sequelae of already established disease. Regarding coronary heart disease, this can mean risk factor management that is carried out during cardiac rehabilitation, a 4-phase process beginning in hospital after MI, angioplasty or heart surgery and continuing for a minimum of three months. Exercise is a main component of cardiac rehabilitation along with diet, smoking cessation, and blood pressure and cholesterol management. | ||
==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=== | ===Anti-platelet therapy=== | ||
Revision as of 05:29, 1 October 2012
|
Coronary heart disease Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Coronary heart disease secondary prevention On the Web |
|
American Roentgen Ray Society Images of Coronary heart disease secondary prevention |
|
Risk calculators and risk factors for Coronary heart disease secondary prevention |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Secondary prevention
Secondary prevention is preventing further sequelae of already established disease. Regarding coronary heart disease, this can mean risk factor management that is carried out during cardiac rehabilitation, a 4-phase process beginning in hospital after MI, angioplasty or heart surgery and continuing for a minimum of three months. Exercise is a main component of cardiac rehabilitation along with diet, smoking cessation, and blood pressure and cholesterol management.
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.".[1]
References
- ↑ Keller T, Squizzato A, Middeldorp S (2007). "Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular disease". Cochrane database of systematic reviews (Online) (3): CD005158. doi:10.1002/14651858.CD005158.pub2. PMID 17636787.