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CME Objective: To review current evidence for diagnosis, treatment, and practice improvement of stable ischemic heart disease.
Funding Source: American College of Physicians.
Disclosures: Ms. Wilson, ACP Contributing Author, has disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2656.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
With the assistance of additional physician writers, Annals of Internal Medicine editors develop In the Clinic using resources of the American College of Physicians, including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program).
Stable ischemic heart disease (SIHD) affects many millions of Americans, with associated annual costs measured in tens of billions of dollars. It is a leading cause of death in the United States. SIHD occurs when coronary artery disease (CAD) reduces the blood supply to the heart and typically causes recurrent chest pain or pressure known as angina. The angina is exacerbated by activity or stress, lasts for minutes not seconds or hours, and goes away with rest or medication. Timely diagnosis and optimal treatment can reduce complications and mortality from SIHD.
Guideline-directed medical therapy for patients with stable ischemic heart disease. ACCF = American College of Cardiology Foundation; ACEI = angiotensin-converting enzyme inhibitor; AHA = American Heart Association; ARB = angiotensin-receptor blocker; ASA = aspirin; ATP III = Adult Treatment Panel III; BP = blood pressure; CCB = calcium-channel blocker; CKD _chronic kidney disease; JNC VII = Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; LV = left ventricular; MI = myocardial infarction; NHLBI = National Heart, Lung, and Blood Institute; NTG = nitroglycerin. From reference 3. Reprinted with permission from the American College of Physicians.
* The use of bile acid sequestrant is relatively contraindicated when triglyceride levels are 200 mg/dL or greater and is contraindicated when triglyceride levels are 500 mg/dL or greater.
† Dietary supplement niacin must not be used as a substitute for prescription niacin.
Revascularization to improve symptoms of patients with stable ischemic heart disease. CABG = coronary artery bypass grafting; PCI = percutaneous coronary intervention.
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Clinical Slide Set. Stable Ischemic Heart Disease
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