Chronic Coronary Disease The Latest Recommendations скачать в хорошем качестве

Chronic Coronary Disease The Latest Recommendations

Dr Neil Skolnik reviews the latest guidelines for managing patients with stable coronary artery disease in primary care. https://www.medscape.com/viewarticle/... -- TRANSCRIPT -- I'm Dr Neil Skolnik. Today I'm going to talk about the 2023 American College of Cardiology/American Heart Association Guideline for the Management of Patients With Chronic Coronary Disease. Now, let me emphasize, this is about patients with stable diagnosed coronary artery disease (CAD). This is not about managing acute coronary syndromes, myocardial infarction (MI), or post-acute management; those are managed by our cardiology colleagues. Patients with chronic coronary disease represent a large group — over 20 million people in the United States. There's a lot in this guideline, so I'm going to select the parts that are most important for us in primary care. First and new in this guideline is that routine testing for ischemia (such as stress testing) is not recommended except when there is a change in symptoms or functional status. Three trials (COURAGE, ISCHEMIA, and BARI 2D) showed that in patients with stable coronary disease, there's no benefit of revascularization compared with optimal medical therapy. So, when we see patients with coronary disease, we want to make sure that their symptoms are stable and that their medical therapy is optimized. Let's talk about what that means. Nutrition and physical activity — we often skip over these topics, but they are critically important. Mediterranean-style dietary plans can lead to a 65% reduction in composite cardiovascular outcomes like cardiac death and recurrent MI. Higher-quality carbohydrate intake, which means cutting down on highly processed carbohydrates, leads to lower cardiovascular morbidity and mortality, as does lower saturated fat intake. Now, what doesn't work when it comes to diet is fish oils, particularly omega-3 fatty acids, as well as antioxidants like vitamins C and E. Don't forget physical activity — the goal being 150-300 minutes a week of moderate to vigorous aerobic activity. But remember, smaller amounts of activity are also helpful. All of this leads to improved functional capacity and quality of life, and a decrease in hospital admissions and mortality. Resistance training (strength training exercises) should be done 2 or more days a week, and patients should try to reduce the amount of time spent in sedentary activities. Mental health is also important. Depression and anxiety diminish quality of life and lead to worse cardiovascular outcomes. Obviously, if someone is smoking, do your best to get them to quit. https://www.medscape.com/viewarticle/...