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Treatment
Patient Education
Î Patients with SIHD should have an individualized education plan to
optimize care and promote wellness, including:
• Education on the importance of medication adherence for managing symptoms
and retarding disease progression (I-C);
• An explanation of medication management and cardiovascular risk reduction
strategies in a manner that respects the patient's level of understanding, reading
comprehension, and ethnicity (I-B)
• A comprehensive review of all therapeutic options (I-B)
• A description of appropriate levels of exercise, with encouragement to maintain
recommended levels of daily physical activity (I-C)
• Introduction to self-monitoring skills (I-C) and
• Information on how to recognize worsening cardiovascular symptoms and take
appropriate action. (I-C)
Î Patients with SIHD should be educated about the following lifestyle
elements that could influence prognosis: (I-C)
• Weight control – maintenance of a body mass index (BMI) of 18.5-24.9 kg/m
2
and maintenance of a waist circumference <102 cm (40 inches) in men and <88 cm
(35 inches) in women (less for certain racial groups)
• Lipid management
• Blood pressure (BP) control
• Smoking cessation and avoidance of exposure to secondhand smoke
• Individualized medical, nutrition, and lifestyle changes for patients with diabetes
mellitus to supplement diabetes treatment goals and education.
Î It is reasonable to educate patients with SIHD about:
• Adherence to a diet that is low in saturated fat, cholesterol, and trans fat; high
in fresh fruits, whole grains, and vegetables; and reduced in sodium intake, with
cultural and ethnic preferences incorporated (IIa-B);
• Common symptoms of stress and depression to minimize stress-related angina
symptoms (IIa-C);
• Comprehensive behavioral approaches for the management of stress and
depression (IIa-C); and
• Evaluation and treatment of major depressive disorder when indicated. (IIa-B)
Risk Factor Modification
Lipid Management
ÎLifestyle modifications, including daily physical activity and weight
management, are strongly recommended for all patients with SIHD. (I-B)
Î Dietary therapy for all patients should include reduced intake of
saturated fats (to <7% of total calories), trans fatty acids (to <1% of
total calories), and cholesterol (to <200 mg/d). (I-B)
Î In addition to therapeutic lifestyle changes, a moderate or high
dose of a statin therapy should be prescribed in the absence of
contraindications or documented adverse effects. (I-A)
