New U.S. guidelines on chronic coronary disease rethink use of beta-blockers, other medications
The American College of Cardiology (ACC) and American Heart Association (AHA) have published new guidelines focused on the diagnosis, treatment and management of patients with chronic coronary disease (CCD).
The new document is available in full in both the Journal of the American College of Cardiology and Circulation.[1,2] It represents an update to guidelines first published in 2012 and 2014.[3, 4]
The guidelines define CCD as any patient presenting with long-term vascular or heart conditions involving inadequate blood flow to or from the heart. This includes patients with chronic chest pain and patients with a history of myocardial infarction, treatment with a coronary stent or bypass surgery.
“The good news is that CCD is a very manageable disease now,” cardiologist Salim S. Virani, MD, PhD, chair of the writing committee behind the guidelines, said in a prepared statement. “With healthy lifestyle habits and medical therapy, which has advanced tremendously, the prognosis for patients with CCD has dramatically improved.”
Communication’s role in the management of chronic coronary disease
The new ACC/AHA guidelines highlight the continued importance of communicating with patients.
“It is crucial for patients with CCD to have regular conversations about their condition with their healthcare professionals,” Virani explained. “These discussions are needed to ensure that patients are following the most recent diet, physical activity and other lifestyle recommendations and receiving all the appropriate evidence-based therapies.”
Of course, communication among healthcare providers is just as important to patient care.
“Management of CCD is a team sport,” Virani added. “Clinicians in both primary and specialty care should fully leverage all members of the cardiovascular care team, including physicians, nurse practitioners, physician assistants, nurses and nursing assistants, pharmacists, dietitians, exercise physiologists, physical, occupational and speech therapists, psychologists and social workers to maximize benefits to patients with CCD.”
Key points on medication use from the new American College of Cardiology/American Heart Association recommendations
The document’s writing group provided some updated thoughts on the use of a variety of medications:
- SGLT-2 inhibitors and GLP-1 receptor agonists can provide CCD patients with “potential cardiovascular benefits,” including weight loss and a reduced risk of adverse events, even among patients who do not have type 2 diabetes.
- Beta-blockers should only be routinely used for up to one year by patients with CCD who have not had a myocardial infarction in the past year or have a left ventricular ejection fraction of 50% or higher.
- While statins are still a “first choice” for lowering cholesterol among CCD patients, “new cholesterol-lowering medicines” such as ezetimibe, PCSK9 inhibitors, bempedoic acid and inclisiran “may be considered” in instances when statins are either ineffective or not tolerated well.
- Nutritional supplements not prescribed by a doctor are not recommended. This includes vitamin D supplements, calcium supplements, etc.
When follow-up medical imaging exams are not recommended
The ACC/AHA guidelines also wrote that routing follow-up screening with stress testing or CT is not recommended for CCD patients on guideline-directed medical therapies who have not experienced changes in their symptoms.
Read the full recommendations in the Journal of the American College of Cardiology here or Circulation here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.