1, 2, 9 вЂ“ 12 Patients 75 years and older and those who cannot tolerate high-intensity statin therapy should receive moderate-intensity statin therapy for secondary prevention 10 this treatment should be individualized for each patient. In their 2013 cholesterol treatment guideline, the American College of Cardiology/American Heart Association (ACC/AHA) transitioned away from low-density lipoprotein (LDL) cholesterol targets to recommend that all patients with stable CAD who are younger than 75 years receive high-intensity statin therapy ( Table 1 10 ), which reduces all-cause mortality compared with less intense therapy. 9 Based on a 20% 10-year risk of a cardiovascular event (typical in patients with stable CAD), this corresponds to a number needed to treat (NNT) of 25 to prevent one event over 10 years. A prospective meta-analysis of 14 randomized controlled trials (RCTs) showed that statin therapy reduces the risk of major cardiovascular events, revascularization, and stroke by 20%.

1, 2 All patients with stable CAD should receive annual influenza vaccination to decrease the risk of cardiovascular events. 1, 3 Physicians should offer pharmacotherapy or referral to smoking cessation programs if necessary. 7 Smoking cessation is recommended for all patients with or at risk of CVD because cessation decreases morbidity and mortality rates to those of nonsmokers roughly 10 years after quitting. Exercise testing is not needed before starting low- to intermediate-intensity programs, although patients at high risk should be enrolled in a medically supervised program for eight to 12 weeks.

1, 5, 6 Exercise is safe in patients with stable CAD. 3, 4 LIFESTYLE MODIFICATIONД®ngaging in 30 to 60 minutes of moderate-intensity aerobic activity (e.g., brisk walking) five to seven days per week and increasing daily lifestyle activities have been shown to reduce cardiovascular mortality (risk ratio = 0.74 95% confidence interval, 0.64 to 0.86) and possibly all-cause mortality in patients with stable CAD, although they do not seem to reduce the risk of MI or revascularization. Lifestyle modifications (e.g., smoking cessation, increased physical activity, weight control, healthy diet) and management of comorbid conditions such as hypertension and diabetes mellitus can reduce overall and CVD-related mortality. Risk reduction to prevent cardiovascular events includes blood pressure (BP) control and management of cholesterol and glucose levels.

Management of Risk Factors and Comorbidities.

3 Treatment of stable CAD involves lifestyle changes, risk factor modification, and antiplatelet and antianginal therapy. 3 However, the CVD mortality rate has declined 28% since 2003 because of advances in treatment, risk factor reduction, and prevention.

3 CAD is one of the leading causes of mortality in the United States, accounting for 31% of all deaths in 2013. 1, 2 In the United States, approximately 25% of men and 16% of women 60 to 79 years of age have diagnosed or undiagnosed CAD, or a cardiovascular disease (CVD) equivalent such as stroke or peripheral arterial disease. Patients are considered stable if they are asymptomatic or if their symptoms are controlled by medications or revascularization. Stable coronary artery disease (CAD) refers to a reversible supply/demand mismatch related to ischemia, a history of myocardial infarction (MI), or the presence of plaque documented by catheterization or computed tomography angiography. Select patients may benefit from coronary revascularization with percutaneous coronary intervention or coronary artery bypass grafting. Calcium channel blockers, nitrates, and ranolazine are used as adjunctive or second-line therapy when beta blockers are ineffective or contraindicated. Antianginal medications should be added in a stepwise approach beginning with a beta blocker. Aspirin is the mainstay of antiplatelet therapy clopidogrel is an alternative. Studies of niacin and fibrates as adjunctive therapy found no improvement in patient outcomes. No data support the routine use of monotherapy with nonstatin drugs such as bile acid sequestrants, niacin, ezetimibe, or fibrates. All patients should be started on a statin unless contraindicated. Treatment of comorbidities such as diabetes mellitus, hyperlipidemia, and hypertension should be optimized to reduce cardiovascular risk. Tobacco cessation, exercise, and weight loss are the most important lifestyle modifications.

Treatment involves risk factor management, antiplatelet therapy, and antianginal medications. Patients are considered stable if they are asymptomatic or their symptoms are controlled by medications or revascularization. Stable coronary artery disease refers to a reversible supply/demand mismatch related to ischemia, a history of myocardial infarction, or the presence of plaque documented by catheterization or computed tomography angiography.

Cad disease