Recommendations Developed for Chronic Coronary Disease

In a report from the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines, published online July 20 in Circulation and in the Journal of the American College of Cardiology, recommendations are presented for the diagnosis and management of chronic coronary disease (CCD).

Salim S. Virani, M.D., Ph.D., from the Baylor College of Medicine in Houston, and colleagues conducted a comprehensive literature review to update and consolidate new evidence relating to the diagnosis and management of patients with stable ischemic heart disease.

The authors emphasize team-based, patient-centered care, which considers social determinants of health and associated costs, as well as incorporating shared decision-making in risk assessment, testing, and treatment. All patients with CCD are advised to undergo nonpharmacologic therapies, including healthy dietary habits and exercise. Patients with CCD without contraindications are encouraged to participate in habitual physical activity; for eligible patients, cardiac rehabilitation provides significant cardiovascular benefits. For select groups of patients with CCD, including those without diabetes, the use of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists is recommended. New recommendations have been developed for use of beta blockers in CCD. Statins remain the first-line therapy for lipid lowering in CCD; several adjunctive therapies may be used in select populations. In many circumstances, shorter durations of dual antiplatelets are safe and effective.