38
Treatment
4.3.2. Beta Blockers
COR LOE
Recommendations
1 A 1. In patients with CCD and LVEF ≤40% with or without previous
MI, the use of beta-blocker therapy is recommended to reduce
the risk of future MACE, including cardiovascular death.
1 A 2. In patients with CCD and LVEF <50%, the use of sustained
release metoprolol succinate, carvedilol, or bisoprolol with
titration to target doses is recommended in preference to
other beta blockers.*
2b B-NR 3. In patients with CCD who were initiated on beta-blocker
therapy for previous MI without a history of or current LVEF
≤50%, angina, arrhythmias, or uncontrolled hypertension, it
may be reasonable to reassess the indication for long-term
(>1 year) use of beta-blocker therapy for reducing MACE.
3: No
Benefit
B-NR 4. In patients with CCD without previous MI or LVEF ≤50%,
the use of beta-blocker therapy is not beneficial in reducing
MACE, in the absence of another primary indication for beta-
blocker therapy.
†
* Modified from the 2022 AHA/ACC/HFSA guideline for the management of heart failure.
Heidenreich PA, op. cit.
†
Adapted from the 2021 ACC/AHA/SCAI guideline for coronary artery revascularization.
Lawton JS, et al. op. cit.
4.3.3. Renin-Angiotensin-Aldosterone Inhibitors
COR LOE
Recommendations
1 A 1. In patients with CCD who also have hypertension, diabetes,
LVEF ≤40%, or CKD, the use of ACE inhibitors, or ARBs
if ACE inhibitor–intolerant, is recommended to reduce
cardiovascular events.
2b B-R 2. In patients with CCD without hypertension, diabetes, or
CKD and LVEF >40%, the use of ACE inhibitors or ARBs
may be considered to reduce cardiovascular events.
4.3.4. Colchicine
COR LOE
Recommendation
2b B-R 1. In patients with CCD, the addition of colchicine for
secondary prevention may be considered to reduce recurrent
ASCVD events.
