Optimal Management of Suspected or Known Coronary Artery Disease

Pharmacotherapy for Prevention of Mortality and Morbidity

The American College of Cardiology recommends aspirin for all patients with coronary artery disease (CAD), particularly those with previous myocardial infarction (MI), at daily doses of at least 75mg to reduce cardiovascular events 4
The American Heart Association recommends β-blockers for all patients with previous MI (Level A) and those without previous MI (Level B) to reduce mortality and morbidity 5
The American College of Cardiology recommends statins (LDL-lowering therapy) for all patients with CAD, even with mild-to-moderate LDL elevations, as they significantly reduce adverse ischemic events in established CAD 6
The American Heart Association recommends ACE inhibitors for all patients with CAD, particularly beneficial in those with diabetes, as they reduce cardiovascular death, MI, and stroke 7, 8

The American College of Cardiology recommends sublingual nitroglycerin or nitroglycerin spray as first-line for immediate relief of angina symptoms (Level B) 1, 3
The American Heart Association recommends β-blockers as first-line maintenance therapy for symptom control due to their effects on heart rate, contractility, and potential mortality benefits 5
The American College of Cardiology recommends long-acting calcium channel blockers when β-blockers are contraindicated or when used in combination with β-blockers for inadequate symptom control (Level B) 3, 9

The American Heart Association recommends aspirin for all patients with previous MI (Level A) and may be beneficial for those without previous MI (Level B) 10
The American College of Cardiology recommends β-blockers for patients with previous MI (Level B) 10
The American Heart Association recommends statins for all patients with documented CAD or type 2 diabetes (Level A) 10
The American College of Cardiology recommends ACE inhibitors for patients with CAD who also have diabetes, systolic dysfunction, or both (Level A) 10

The American Heart Association does not recommend dipyridamole as it can enhance exercise-induced myocardial ischemia (Level B) 1, 4
The American College of Cardiology does not recommend chelation therapy due to lack of evidence (Level B) 1
The American Heart Association recommends avoiding short-acting dihydropyridine calcium antagonists due to increased risk of adverse cardiac events 3

The American Diabetes Association notes that diabetes is not a contraindication to β-blocker use; diabetic patients may benefit as much as or more than non-diabetic patients 5
The American Heart Association notes that ACE inhibitors provide particular benefit for secondary prevention in patients with diabetes and CAD 7