Treatment of SIHD - First and Second Strategy
Document5 pagesB.Pharm, Pharm.D
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Treatment of SIHD - First and second strategy.
- SIHD
- ischemic heart disease
- antianginal therapy
- cardiovascular disease
- treatment strategies
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- Page 1. FIRST STRATERGY - RISK FACTOR MODIFICATION
- Page 2. 2. Blood Pressure Management Hypertension increases the risk of MI, stroke, and renal dysfunction. Initiate treatment at ≥130/80–140/90 mmHg depending on patient risk; target <140/90 mmHg or lower if tolerated. β-blockers, ACE inhibitors/ARBs, thiazide diuretics, and dihydropyridine CCBs are preferred agents. Long-term β-blocker therapy is beneficial after ACS when indicated. Lifestyle changes—salt restriction, weight reduction, physical activity, and DASH diet—improve BP control. Aggressive targets (<120 mmHg systolic) may reduce events but increase risk of hypotension and renal effects. 1. Lipid Management Elevated LDL-C increases the risk of MI, stroke, and cardiovascular mortality; every 40 mg/dL LDL reduction lowers all-cause mortality by ~10%. High-intensity statins (atorvastatin 40–80 mg, rosuvastatin 20–40 mg) are preferred unless the patient is elderly or intolerant. Moderate-intensity statins may be used in patients >75 years or with intolerance. If LDL goals are not achieved, add ezetimibe first, then a PCSK9 inhibitor. Lifestyle modifications—reducing saturated/trans fats, adding viscous fiber, plant sterols, and regular physical activity—further lower LDL. Plant sterols (2 g/day) reduce LDL by 5–15%; losing 10 lbs reduces LDL by 5– 8%. Niacin or bile acid sequestrants may be used if statins are not tolerated, though they are less potent. 3. Smoking Cessation Smoking promotes endothelial dysfunction, platelet activation, and reduced HDL, accelerating atheroscleros
- Page 3. 6. Weight Management Maintaining a BMI of 18.5–24.9 kg/m² and proper waist circumference reduces CV risk. Aim for an initial weight loss of 5–10%, with further loss if necessary. Monitor BMI and waist circumference regularly at clinic visits. Combine dietary counseling with increased physical activity for effective weight control. 7. Psychological and Behavioral Health Depression is common in SIHD and worsens adherence and quality of life. Screening for depression is reasonable in this population. Treating depression improves quality of life even if CV outcome benefits are not proven. Addressing emotional and behavioral health supports better adherence to medical therapy. 8. Alcohol Consumption Moderate alcohol intake may be acceptable if not contraindicated. Recommended limits: 1 drink/day for women and 1–2 drinks/day for men. Avoid alcohol in patients with liver disease, alcohol misuse, or other contraindications. Excessive consumption increases cardiovascular and systemic risks. 9. Environmental Factors Air pollution exposure increases cardiovascular risk through inflammation and vascular dysfunction. Patients with SIHD should reduce exposure to polluted environments whenever possible. Avoid outdoor activity during high particulate matter days or peak pollution hours. 10. Influenza Vaccination Annual influenza vaccination is recommended for all patients with SIHD. Reduces the risk of influenza-related complications that can trigger acute cardiac events. Helps prevent hospi
- Page 4. SECOND STRATERGY - ANTI ANGINAL THERAPY RECOMMENDATIONS
- Page 5. Recommendation Details β-blockers as initial therapy Relief of SIHD symptoms CCBs or long-acting nitrates When β-blockers are contraindicated or not tolerated CCBs or long-acting nitrates + β-blockers When initial β-blocker therapy is unsuccessful Sublingual nitroglycerin/nitroglycerin spray Immediate angina relief Long-acting non-DHP CCB (verapamil/diltiazem) instead of β-blocker Reasonable as initial therapy Ranolazine as β-blocker substitute If β-blockers contraindicated, ineffective, or cause side effect Ranolazine + β-blocker Useful when symptoms persist despite β- blockers
