Management of Coronary Artery Disease

Risk Factor Modification and Lifestyle Management

The European Society of Cardiology recommends improvement of lifestyle factors alongside appropriate pharmacological management to reduce all-cause and cardiovascular mortality and morbidity, and improve health-related quality of life 1, 2
Cognitive behavioral interventions should be implemented to help patients achieve a healthy lifestyle, as recommended by the European Society of Cardiology 1, 3
Annual influenza vaccination is recommended for patients with coronary artery disease, especially in older individuals, according to the European Society of Cardiology 1
The European Society of Cardiology recommends a heart-healthy diet, such as the Mediterranean, DASH, or AHA diet, for patients with coronary artery disease 1

The European Society of Cardiology recommends statins in all patients with coronary artery disease, with the aim to reduce LDL-C by ≥50% from baseline and/or achieve LDL-C <1.4 mmol/L (<55 mg/dL) 1, 3
If LDL-C goals are not achieved after 4-6 weeks with maximally tolerated statin dose, combination with ezetimibe is recommended by the European Society of Cardiology 1
Beta-blockers are recommended as first-line therapy for patients with previous MI and for symptom control in angina, according to the American College of Cardiology 4
The American Heart Association recommends short-acting nitrates for immediate relief of angina symptoms 6
ACE inhibitors (or ARBs if ACE inhibitors are not tolerated) are recommended in patients with heart failure with reduced LVEF (<40%), diabetes, or chronic kidney disease, as recommended by the European Society of Cardiology 1, 4

The European Society of Cardiology recommends myocardial revascularization when angina persists despite treatment with antianginal drugs 2
Revascularization should be considered for patients with obstructive coronary artery disease who are at high risk of adverse events, not only for symptom relief but also to prevent spontaneous MI and cardiac death, according to the European Society of Cardiology 7
High-risk patients with left ventricular systolic dysfunction, diabetes mellitus, and those with severe 3-vessel or left main disease should be considered for coronary artery bypass grafting, as recommended by the American Heart Association 6

Regular follow-up visits to monitor symptoms, medication adherence, and risk factor control are recommended by the European Society of Cardiology 1, 4
Involvement of multidisciplinary healthcare professionals is recommended to improve outcomes in patients with coronary artery disease, according to the European Society of Cardiology 1, 4
Psychological interventions should be implemented to improve symptoms of depression in patients with coronary artery disease, as recommended by the European Society of Cardiology 1

In patients with diabetes, screening for coronary artery disease is recommended, and blood glucose levels should be monitored frequently, according to the European Society of Cardiology 1
For older persons with coronary artery disease, the same diagnostic and interventional strategies should be applied as for younger patients, with medication dosages adapted to renal function and specific contraindications, as recommended by the European Society of Cardiology 1