Chronic stable angina secondary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.

Overview
In patients with chronic stable angina, initiation of intensive risk factor modification remains an urgent and essential part of secondary prevention strategy, as they directly influence the prognosis. Based on the 27th Bethesda Conference, risk factor modification is divided into four categories according to both the strength of evidence for causation and the evidence that risk factor modification established significant reduction in the occurrence of future coronary events.

==Proposed Risk Factor Categories based on the 27th Bethesda Conference == Category I: Risk factors for which interventions have proved to reduce the incidence of coronary artery disease events such as cigarette smoking, LDL cholesterol, dietary modification, hypertension and thrombogenic factors.

Category II: Risk factors for which interventions are likely, based on our current pathophysiologic understanding and on epidemiologic and clinical trial evidence, to reduce the incidence of coronary artery disease events such as diabetes, physical inactivity, HDL cholesterol, obesity and postmenopausal status.

Category III: Risk factors clearly associated with an increase in coronary artery disease risk and which, if modified, might lower the incidence of coronary artery disease events such as psychosocial factors, triglycerides, Lp(a), homocysteine, oxidative stress and alcohol consumption.

Category IV: Risk factors associated with increased risk but which cannot be modified or whose modification would be unlikely to change the incidence of coronary artery disease events such as age, gender, family history and many others.

==European Systematic Coronary Risk Evaluation (SCORE) system ==


 * The SCORE project, assembled a pool of datasets from 12 European cohort studies, representing 2.7 million person years of follow-up to predict any kind of fatal cardiovascular event over a ten-year period.
 * This system includes both non-modifiable and modifiable coronary risk factors such as:
 * Age
 * Gender
 * Systolic blood pressure
 * Smoking
 * Total cholesterol and/or cholesterol:HDL ratio
 * to estimate a person’s total ten-year risk of cardiovascular death.


 * Patients with established coronary artery disease, diabetics with microalbuminuria, asymptomatic patients with multiple risk factors are considered high-risk for the development of fatal coronary event.
 * The threshold for being at high-risk according to the SCORE system is defined as greater than or equal to 5% since it estimates the fatal events and not the composite primary end-point. This system is shown to be most helpful in the decision-making process to intensify secondary prevention strategies. Hence, the SCORE risk estimation system offers direct estimation of total fatal cardiovascular risk in a format suited to the constraints of clinical practice.

Individual Topics for Secondary Prevention
You can read in greater detail about each of the risk factor modification topic below by clicking on the link for that topic.
 * Smoking Cessation
 * Weight Management
 * Physical Activity
 * Lipid management
 * BP control
 * Diabetes control
 * ACC/AHA Guidelines for Cardiovascular Risk Factor Reduction

Vote on and Suggest Revisions to the Current Guidelines

 * The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Guidelines Resources

 * Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiolog


 * The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina


 * The ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina


 * The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina