Stable ischemic heart disease

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
• RAS inhibitors: indicated with acute MI, heart failure, LCEF <40%, diabetes, and proteinuric chronic kidney disease