Stable ischemic heart disease
From IDWiki
Management
Risk Factor Modification
- Dyslipidemia
- If CV risk >20%, high-intensity statin regardless of baseline lipids
- If CV risk 7.5 to 20%, can use moderate-intensity statin
- Hypertension
- Following lifestyle modification, preference should be given to ACE inhibitors and ARBs
- Diabetes mellitus
- Good glycemic control
- Likely benefits from SGLT-2 inhibitors
- Diet & exercise
- Cardiac rehab
- Annual influenza vaccination
Coronary Artery Disease
- Antiplatelet therapy: long-term ASA is recommended
- Anticoagulation: can consider low-dose rivaroxaban 2.5 mg PO bid in addition to ASA if at high risk for CV disease and low bleeding risk
- Lipid-lowering: see above
- Beta-blockers
- Used primarily as anti-anginal medication
- Alternatives include calcium channel blockers and long-acting nitrates
- Can use combination therapy if still symptomatic
- Definitely indicated after ACS or heart failure, but unclear benefit in stable IHD
- Used primarily as anti-anginal medication
- RAS inhibitors: indicated with acute MI, heart failure, LCEF <40%, diabetes, and proteinuric chronic kidney disease
