20180410 stable coronary artery disease treatment
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This document discusses the treatment of stable coronary artery disease. It recommends lifestyle modifications like exercise, smoking cessation, and weight loss. It also recommends treating comorbidities through medications for blood pressure, cholesterol and blood sugar. Drug therapies include aspirin, clopidogrel, statins, beta blockers, calcium channel blockers, nitrates and ranolazine for angina relief. Revascularization through percutaneous coronary intervention or coronary artery bypass grafting may be considered depending on severity of disease and patient preferences. The goal is to reduce risks and manage symptoms through a combination of medical therapies and addressing modifiable risk factors.
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20180410 stable coronary artery disease treatment
- 1. Stable Coronary Artery Disease 20180410 Intern 陳佳菁 TREATMENT
- 2. Am Fam Physician. 2018;97(6):376-384. Michael M. Braun, DO, and William A. Stevens, MD Madigan Army Medical Center, Joint Base Lewis-McCord, Washington Craig H. Barstow, MD, Womack Army Medical Center, Fort Bragg, North Carolina
- 3. Ischemia PlaqueHx of MI Reversible Supply/ Demand Mismatch
- 4. 1 2 CAD Asymptomatic Sx controlled by Medications or Revascularization STABLE ?
- 8. Anti-Platlet Anti-Anginal 治療 Risk Factors Comorbidities Reduce Risk Modify Lifestyle Manage Comorbid Condition Overall & CVD-related Mortality
- 12. Lifestyle Cholesterol BP Diabetes 30-60 min. Moderate-Intensity Aerobic Activity 5-7 days / weeks
- 13. Lifestyle Cholesterol BP Diabetes ALL PATIENTS ! ! ! Pharmacotherapy / Programs
- 14. Lifestyle Cholesterol BP Diabetes Annual Influenza Vaccination
- 15. Lifestyle Cholesterol BP Diabetes CV events, Revascularization, Stroke: 20% Statin
- 16. Lifestyle Cholesterol BP Diabetes Statin < 75 yr ≥ 75 yr HIGH Intensity MODERATE Intensity American College of Cardiology / American Heart Association, 2013 cholesterol treatment guideline
- 17. Lifestyle Cholesterol BP Diabetes American College of Cardiology / American Heart Association 2013 cholesterol treatment guideline
- 18. Lifestyle Cholesterol BP Diabetes - Bile acid sequestrants - Niacin - Ezetimibe - Fibrates Non-statin Monotherapy
- 19. Lifestyle Cholesterol BP Diabetes Combination to Statin: NO benefit Non-statin
- 20. Lifestyle Cholesterol BP Diabetes Injectable Monoclonal Ab LDL PCSK9 INB
- 21. Lifestyle Cholesterol BP Diabetes Evolocumab, Alirocumab Risks of MI, Revascularization PCSK9 INB
- 22. Lifestyle Cholesterol BP Diabetes PCSK9 INBNon-statin High-risk Patients
- 23. Lifestyle Cholesterol BP Diabetes Eighth Joint National Committee guidelines 2012 ACC/AHA/ European Society of Cardiology practice guideline 2017 guideline on high BP from the ACC/ AHA 150/90mmHg 140/90mmHg 140/80mmHg 130/80mmHg
- 24. Lifestyle Cholesterol BP Diabetes SBP (mmHg) 120 140 All-cause Mortality Heart Failure Risk Hypotension Acute Kidney Injury Electrolyte Abnormality Additional Medication
- 25. Lifestyle Cholesterol BP Diabetes Initial Therapy Race Diabetes ACEi ARB CCB Thiazide CCB ACEi ARB
- 26. Lifestyle Cholesterol BP Diabetes < 65 yr ≥ 65 yr A1C < 7% A1C 7-8% Metformin Liraglutide Semaglutide Empagliflozin
- 28. 75 to 162 = 325 mg/day 81 mg/day Low Cost, Known Benefit
- 29. Clopidogrel - Alternative Irreversibly Inhibit Platlet Aggregation
- 30. All-cause Mortality Risk of Bleeding Dual Antiplatlet Therapy
- 32. Ticagrelor, Prasugrel More Potent Only in ACS - PCI
- 33. ICH ! ! ! CV Mortality, MI, CVA
- 37. When Beta Blocker Do not Control Symptoms
- 38. If Monotherapy is Ineffective or Intolerated
- 40. Recent MI, Abnormal left ventricular function No MI Improve Survival Reduce MI Recurrence 3 Years Reduced CV Rates Increased CVA Risk Effective Antianginals Recommend: Initial Therapy Cardioselective: β1 Receptors Heart Failure: Metoprolol succinate, Carvedilol Beta Blockers
- 41. CCB Intolerant to Beta Blockers Angina uncontrolled with Beta Blockers Abnormal LV Function Reflex tachycardia, Exacerbating ischemia Increasing harm risk Amlodipine Extended-release Nifedipine Non-DHP Verapamil, Diltiazem DHP Amlodipine, Nifedipine 時機 禁⽤用 短效 長效
- 42. Nitrate Quick onset, Immediate relief短效 長效 BB, CCBs 發作次數 運動耐受 短效 NTG 需求 Alternative Adjunctive
- 43. Ranolazine Inhibit late inward Na+ Angina, Bradycardia, Low BP Alternative to: Beta Blockers / CCB Hepatic Impairment 時機 禁⽤用 QT Prolong注意 Ventricular Diastolic Tension Myocardial Oxygen Demand 作⽤用
- 49. SUMMARY
- 50. Ischemia PlaqueHx of MI Reversible Supply/ Demand Mismatch
- 51. 1 2 CAD Asymptomatic Sx controlled by Medications or Revascularization STABLE ?
- 53. 1 Anti-Platlet Anti-Anginal 治療 Risk Factors Comorbidities Lifestyle Modification 運動 戒菸 減重
- 54. 1 Anti-Platlet Anti-Anginal 治療 Risk Factors Comorbidities Comorbidity Treatment ⾎血壓 ⾎血脂 ⾎血糖
- 55. Anti-Platlet Anti-Anginal 治療 Risk Factors Comorbidities Statin Non-statin Monotherapy1
- 56. Anti-Platlet Anti-Anginal 治療 Risk Factors Comorbidities 2 Clopidogrel Aspirin
- 57. Anti-Platlet Anti-Anginal 治療 Risk Factors Comorbidities 3 Beta Blocker CCB Nitrates Ranolazine Medication
- 58. 3 Anti-Platlet Anti-Anginal 治療 Risk Factors Comorbidities Re- Vascularization PCI CABG 內 外
- 60. 謝 謝！