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Top 10 Take-Home Messages for Chronic Coronary Disease
1. Emphasis is on team-based, patient-centered care that considers
social determinants of health along with associated costs while
incorporating shared decision-making in risk assessment, testing,
and treatment.
2. Nonpharmacologic therapies, including healthy dietary habits and
exercise, are recommended for all patients with CCD.
3. Patients with CCD who are free from contraindications are
encouraged to participate in habitual physical activity, including
activities to reduce sitting time and to increase aerobic and
resistance exercise. Cardiac rehabilitation for eligible patients
provides significant cardiovascular benefits, including decreased
morbidity and mortality outcomes.
4. Use of sodium glucose cotransporter 2 inhibitors and glucagon-like
peptide-1 receptor agonists are recommended for select groups of
patients with CCD, including groups without diabetes.
5. New recommendations for beta-blocker use in patients with CCD:
(a) Long-term beta-blocker therapy is not recommended to improve
outcomes in patients with CCD in the absence of myocardial
infarction in the past year, left ventricular ejection fraction ≤50%, or
another primary indication for beta-blocker therapy; and (b) Either
a calcium channel blocker or beta blocker is recommended as first-
line antianginal therapy.
6. Statins remain first line therapy for lipid lowering in patients with
CCD. Several adjunctive therapies (eg, ezetimibe, PCSK9 [proprotein
convertase subtilisin/kexin type 9] inhibitors, inclisiran, bempedoic
acid) may be used in select populations, although clinical outcomes
data are unavailable for novel agents such as inclisiran.
7. Shorter durations of dual antiplatelet therapy are safe and effective
in many circumstances, particularly when the risk of bleeding is high
and the ischemic risk is low to moderate.
8. The use of nonprescription or dietary supplements, including fish oil
and omega-3 fatty acids or vitamins, is not recommended in patients
with CCD given the lack of benefit in reducing cardiovascular events.
9. Routine periodic anatomic or ischemic testing without a change in
clinical or functional status is not recommended for risk stratification
or to guide therapeutic decision-making in patients with CCD.
10. Although e-cigarettes increase the likelihood of successful smoking
cessation compared with nicotine replacement therapy, because of the
lack of long-term safety data and risks of sustained use, e-cigarettes
are not recommended as first-line therapy for smoking cessation.
