Cardiology societies update guideline on management of chronic coronary disease
The guideline from the American Heart Association and the American College of Cardiology emphasizes coordinating care between cardiovascular and primary care professionals and prioritizing symptom relief and quality of life, among other recommendations.
A heart-healthy diet and lifestyle are the best ways for patients with chronic coronary disease to prevent worsening health, according to a new joint guideline.
The guideline, which was previously updated in 2014, affirms the value of a healthy diet, regular physical activity, and not smoking and updates several recommendations on medications, including sodium-glucose cotransporter-2 (SGLT-2) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, beta-blockers, bempedoic acid, and inclisiran. It was published on July 20 by the American Heart Association and the American College of Cardiology in Circulation and the Journal of the American College of Cardiology.
According to the guideline, three priorities for managing patients with chronic coronary disease include treatment based on a patient's risk for future cardiovascular events, symptom relief and quality of life, and team-based care, including primary care clinicians in collaboration with cardiology specialists.
The guideline recommends clinicians perform a comprehensive risk assessment at annual follow-up visits to evaluate medical and social factors associated with heart health. Clinicians should share risk assessment with their patients and educate them on symptom management and treatment options so they can participate in care decisions.
Additional medication and lifestyle recommendations from the guideline include the following.
- New in this update, routine use of beta-blockers for longer than one year is not recommended in patients with chronic coronary disease who have not had a heart attack within the past year or those whose left ventricular ejection fraction is at or above 50%.
- SGLT-2 inhibitors and GLP-1 receptor agonists may have cardiovascular benefits in addition to controlling blood glucose levels and can also help with weight loss, reduce kidney disease progression, and reduce risk for cardiovascular events in patients with chronic coronary disease who do not have type 2 diabetes.
- While statins remain the first choice of medications to lower cholesterol levels, newer medicines, such as ezetimibe, PCSK9 inhibitors, bempedoic acid, and inclisiran, may be considered for patients whose levels remain high or who do not tolerate statins.
- Shorter duration of dual antiplatelet therapy is recommended in many cases.
- Evidence is not sufficient to determine whether nonprescription nutrition or dietary supplements, including omega-3 fatty acids, vitamins C, D, or E, beta-carotene, or calcium, are helpful.
- Routine follow-up screening with stress testing or CT is not recommended for patients who are on guideline-directed therapies and have no changes in symptoms or functional status.
- The guideline recommends behavioral interventions in combination with nicotine replacement therapy to aid smoking cessation. Short-term use of e-cigarettes may be considered in consultation with a medical professional, but patients who use e-cigarettes to quit smoking should be warned about the risk for developing long-term dependence on them and should be encouraged to quit promptly to avoid potential long-term risks. E-cigarettes are not recommended as first-line therapy for smoking cessation for people with chronic coronary disease, the guideline said.