Management of Chronic Coronary Disease: A Guideline Topline in 10 Take-Home Messages
The 10 take-home points from the ACC/AHA cover diet, exercise, cardiac rehab, use of new treatments, reliance on statins, guidance on beta-blockers, plus more.
The 2023 clinical practice guideline on management of patients with chronic coronary disease issued by a joint committee of the American Heart Association and American College of Cardiology is the first update on the topic since 2012, reflecting published studies, reviews and meta-analyses identified in a comprehensive review conducted from September 2021 to May 2022.
Updates to the 2023 recommendations incorporate evidence for including new therapies in treatment plans, for discontinuing use of older therapies, for extending or truncating duration of therapies, and for increasing focus on the role of social determinants of health in the etiology of disease and the barriers they may pose to reducing morbidity and mortality.
The joint committee identified "Top 10 Take-Home Messages" from the guideline, and these are described in this Topline, along with their application for patients who have, or at risk of developing cardiovascular disease.
Effective management of chronic coronary disease requires a team-based, patient-centered approach
All individuals with chronic coronary disease should follow healthy dietary habits and pursue regular physical activity
Cardiac rehabilitation provides significant CV benefits for individuals with chronic coronary disease, including decreased morbidity and mortality
Weight management is a central to cardiac rehabilitation for individuals with chronic coronary disease
Blood pressure management is central to effective cardiac rehabilitation for individuals with chronic coronary disease
SGLT-2 inhibitors and GLP-1 receptor agonists can be effective in individuals with chronic coronary disease, independent of type 2 diabetes
ACC/AHA guidelines offer updated recommendations for long-term use of beta-blockers.
Statin therapy remains first-line treatment for lowering lipids in persons with chronic coronary disease
For individuals with chronic coronary disease who do not reach target LDL-C levels, consider adding ezetimibe or a PCSK9 inhibitor
Duration of dual antiplatelet therapy has been shortened, particularly in persons with chronic coronary disease who have high risk of bleeding and low risk of ischemic events
ACC/AHA makes specific recommendations for DAPT in individuals requiring anticoagulation with a DOAC following PCI
In persons with chronic coronary disease, ACC/AHA recommends against use of nonprescription or dietary supplements
Routine periodic imaging/testing in persons with chronic coronary disease is NOT recommended unless there is change in clinical function or status
