Amir Qaseem, MD, PhD, MHA; Stephan D. Fihn, MD, MPH; Paul Dallas, MD; Sankey Williams, MD; Douglas K. Owens, MD, MS; Paul Shekelle, MD, PhD; for the Clinical Guidelines Committee of the American College of Physicians*
Note: Clinical practice guidelines are “guides” only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP clinical practice guidelines are considered automatically withdrawn or invalid 5 years after publication or once an update has been issued.
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations.
Financial Support: Financial support for the development of this guideline comes exclusively from the ACP operating budget.
Potential Conflicts of Interest: Any financial and nonfinancial conflicts of interest of the group members were declared, discussed, and resolved according to ACP's conflicts of interest policy. A record of conflicts of interest is kept for each Clinical Guidelines Committee meeting and conference call and can be viewed at www.acponline.org/clinical_information/guidelines/guidelines/conflicts_cgc.htm. Author and peer reviewer disclosure information for the multisocietal stable IHD guideline, on which these guidelines are based, may be found in the published multisocietal document (2). Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1770.
Requests for Single Reprints: Amir Qaseem, MD, PhD, MHA, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Qaseem: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Fihn: 1100 Olive Way, Seattle, WA 98101.
Dr. Dallas: 1906 Bellview Avenue, Roanoke, VA 24014.
Dr. Williams: 423 Guardian Drive, Philadelphia, PA 19104.
Dr. Owens: 117 Encina Commons, Stanford, CA 94305.
Dr. Shekelle: 11301 Wiltshire Boulevard, Los Angeles, CA 90073.
Author Contributions: Conception and design: A. Qaseem, S.D. Fihn, D.K. Owens, P. Shekelle.
Analysis and interpretation of the data: A. Qaseem, S.D. Fihn, P. Dallas, S. Williams, D.K. Owens.
Drafting of the article: A. Qaseem, P. Dallas, S. Williams, D.K. Owens.
Critical revision of the article for important intellectual content: A. Qaseem, S.D. Fihn, P. Dallas, S. Williams, D.K. Owens, P. Shekelle.
Final approval of the article: A. Qaseem, S.D. Fihn, S. Williams, D.K. Owens, P. Shekelle.
Statistical expertise: A. Qaseem.
Administrative, technical, or logistic support: A. Qaseem.
Collection and assembly of data: A. Qaseem, S.D. Fihn.
The American College of Physicians (ACP) developed this guideline with the American College of Cardiology Foundation (ACCF), American Heart Association (AHA), American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, and Society of Thoracic Surgeons to present the available evidence on the management of stable known or suspected ischemic heart disease.
Literature on this topic published before November 2011 was identified by using MEDLINE, Embase, Cochrane CENTRAL, PsychINFO, AMED, and SCOPUS. Searches were limited to human studies published in English. This guideline grades the evidence and recommendations according to a translation of the ACCF/AHA grading system into ACP's clinical practice guidelines grading system.
The guideline includes 48 specific recommendations that address the following issues: patient education, management of proven risk factors (dyslipidemia, hypertension, diabetes, physical activity body weight, and smoking), risk factor reduction strategies of unproven benefit, medical therapy to prevent myocardial infarction and death and to relieve symptoms, alternative therapy, revascularization to improve survival and symptoms, and patient follow-up.
The American College of Physicians Guideline Grading System
Comparison of Grading Systems From the ACP and ACCF/AHA
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.
* 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 survival of patients with stable ischemic heart disease.
Revascularization to improve symptoms of patients with stable ischemic heart disease.
CABG = coronary artery bypass grafting; PCI = percutaneous coronary intervention.