This section covers the management of CAD and PAD, looking at guideline recommendations and revascularization procedures
In this section:
Management of CAD and PAD can be challenging.
- Patients who have both diseases together are at higher risk of morbidity and mortality, and aggressive management strategies are recommended
- Patients with both CAD and PAD frequently experience poorer hospital outcomes compared with patients with CAD alone
The European Society of Cardiology (ESC) guidelines state that management should include lifestyle advice, patient education, pharmacological therapy and/or revascularization.
Lifestyle advice can reduce several risk factors for cardiovascular disease and includes:
- Not smoking, taking regular exercise, maintaining a healthy weight and eating a balanced diet
- A diet low in saturated fats and salt, high in fruit and vegetables and to include a moderate intake of oily fish
Pharmacological management of CAD includes:
- Short-acting nitrates, beta blockers and/or calcium channel blockers as first-line therapy for angina/ischaemia relief
- Low-dose ASA and statins, with an angiotensin-converting-enzyme inhibitor if co-morbidities are present (e.g. diabetes, heart failure, hypertension)
Even with appropriate therapies, patients with co-morbidities may still be at an increased risk of cardiovascular events. For example, patients with diabetes had a 2.9-fold higher risk of cardiovascular events despite receiving patient education on reducing their risk of secondary events and drug prescription after ACS versus patients with CAD alone (18-month follow-up).
Medical management of stable CAD
aData for diabetics; bif intolerance, consider clopidogrel
ACEI, angiotensin-converting-enzyme inhibitor; ARB, angiotensin receptor blocker; CCB, calcium channel blocker; CCS, Canadian Cardiovascular Society; DHP, dihydropyridine
CABG and PCI are the two main forms of revascularization procedures:
- Revascularization decisions are based on the presence of significant obstructive coronary artery stenosis and related ischaemia (e.g. post-MI, left ventricular dysfunction), current symptoms and expected benefit
- Revascularization is recommended if the patient has any significant stenosis (>50%) or a large area of ischaemia
- PCI is associated with a low mortality risk of <0.5% in stable CAD patients; however, poorer outcomes are expected if lower-extremity PAD is also present
- Patients with stable CAD undergoing PCI are also recommended to have anticoagulant and antiplatelet therapy
Approval No.: G.MKT.GM.XA.08.2016.1047
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