Over 20 million people in the U.S. suffer from chronic coronary disease (CCD), a cluster of long-term heart conditions resulting from inadequate blood flow to or from the heart.
The American Heart Association and the American College of Cardiology have released a new joint guideline, underscoring the value of a heart-healthy diet, an active lifestyle, and smoking cessation in managing CCD.
It also recommends new medications according to the latest scientific data.
Principles for Chronic Coronary Disease Management
The guideline recommends a three-pronged approach to managing CCD:
- Tailoring treatment based on a patient’s risk for future cardiovascular events.
- Recognizing the importance of symptom relief and quality of life.
- Advocating for a team-based care approach, involving primary care clinicians and cardiology specialists.
Evaluating Risk and Emphasizing Patient Participation
Quality of life should be a key consideration in treatment decisions, and this includes understanding the patient’s perspective.
The guideline recommends a comprehensive risk assessment at annual follow-up visits to identify all medical and social factors that impact heart health in CCD patients.
It stresses that patients should be educated about symptom management and treatment options and be active participants in decisions about their care.
Medication Recommendations in the Guideline
Among the notable recommendations, the guideline suggests the use of glucose-lowering medications – SGLT-2 inhibitors and GLP-1 receptor agonists – even for CCD patients without Type 2 diabetes, due to their cardiovascular benefits.
While beta-blockers remain crucial, their long-term use beyond one year is not advised for certain groups of patients.
Statins are still the primary choice for cholesterol management, but new medications like ezetimibe, PCSK9 inhibitors, bempedoic acid, and inclisiran can be considered for patients with high cholesterol levels or intolerance to statins.
Dual antiplatelet therapy duration is also recommended to be shorter in many circumstances.
Smoking Cessation and Discouraging Unnecessary Tests
In terms of lifestyle modifications, the guideline emphasizes the importance of smoking cessation and proposes a combination of behavioral interventions and nicotine replacement therapy.
Short-term e-cigarette use may be considered in select cases, but patients should be warned about the risk of e-cigarette dependence and the lack of long-term safety data.
Finally, routine follow-up screening with stress testing or computed tomography is discouraged for patients with stable symptoms on guideline-directed therapies.
Non-prescription nutrition or dietary supplements, including omega-3 fatty acids and certain vitamins, are not recommended due to lack of evidence supporting their benefits for CCD.
Team-Based Care and Addressing Social Determinants
The guideline emphasizes a team-based approach, involving a range of healthcare professionals. It acknowledges the evolution of understanding about the role of social determinants of health and the need for shared decision-making.
The document consolidates new information and offers updated evidence-based recommendations to guide care for people with CCD.
These new guidelines reflect the growing body of evidence supporting the importance of lifestyle management in heart disease, alongside the use of new and traditional medications.
This comprehensive approach aims to optimize patient outcomes and improve the quality of life for those living with chronic coronary disease.
If you care about health, please read studies about the benefits of low-dose lithium supplements, and what we know about egg intake and heart disease.
For more information about health, please see recent studies about potatoes and high blood pressure, and results showing the 6 best breads for people with heart disease.
The study was published in Circulation.
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