2023 Chronic Coronary Disease Guideline-at-a-Glance: 10 Take Home Messages
- Emphasis is on team-based, patient-centered care that considers social determinants of health along with associated costs while incorporating shared decision making in risk assessment, testing, and treatment.
- Nonpharmacologic therapies, including healthy dietary habits and exercise, are recommended for all patients with chronic coronary disease.
- Patients with chronic coronary disease who are free from contraindications are encouraged to participate in habitual physical activity, including activities to reduce sitting time and to increase aerobic and resistance exercise. Cardiac rehabilitation for eligible patients provides significant cardiovascular benefits, including decreased morbidity and mortality outcomes.
- Use of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists are recommended for select groups of patients with chronic coronary disease, including groups without diabetes.
- New recommendations for beta-blocker use in patients with chronic coronary disease: a) long term beta-blocker therapy is not recommended to improve outcomes in patients with chronic coronary disease in the absence of myocardial infarction in the past year, left ventricular ejection fraction £50%, or another primary indication for beta-blocker therapy; and b) either a calcium-channel blocker or betablocker is recommended as first-line antianginal therapy.
- Statins remain first-line therapy for lipid lowering in patients with chronic coronary disease. Several adjunctive therapies (eg, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, inclisiran, bempedoic acid) may be used in select populations, although clinical outcomes data are unavailable for novel agents such as inclisiran.
- Shorter durations of dual antiplatelet therapy are safe and effective in many circumstances, particularly when the risk of bleeding is high and the ischemic risk is low to moderate.
- The use of nonprescription or dietary supplements, including fish oil and omega-3 fatty acids or vitamins, is not recommended in patients with chronic coronary disease given the lack of benefit in reducing cardiovascular events.
- Routine periodic anatomic or ischemic testing without a change in clinical or functional status is not recommended for risk stratification or to guide therapeutic decision-making in patients with chronic coronary disease.
- Although e-cigarettes increase the likelihood of successful smoking cessation compared with nicotine replacement therapy, because of the lack of long-term safety data and risks of sustained use, e-cigarettes are not recommended as first-line therapy for smoking cessation
