Chronic Coronary Disease Guidelines Updated by European Society of Cardiology

William Wijns, MD, PhD

The European Society of Cardiology (ESC) released new guidelines, designed by an international task force of more than 2 dozen physicians, for the diagnosis and treatment of chronic coronary diseases during the ESC Congress 2019 in Paris, France. 



The 2019 guidelines, which includes information regarding the detrimental impact noise and pollution can have on chronic coronary syndromes, is an update to previous stable coronary artery disease (CAD) guidelines. 



“This reflects the fact that CAD can be acute (covered in separate guidelines) or chronic and both are dynamic conditions," said William Wijns, MD, PhD, chairperson of the guidelines Task Force and professor of interventional cardiology at the Lambe Institute for Translational Medicine, Galway, Ireland. "Therapy is lifelong and aimed at preventing progression of the disease and cardiac events such as heart attacks."

Differentiating itself from past guidelines in coronary diseases, the 2019 guidelines place a greater emphasis on lifestyle. Support lifestyle choices in the guidelines included quitting smoking, avoiding passive smoking eating a diet high in vegetables, fruit, and whole grains, and limited intake of saturated fat and alcohol. Patients body weight should be in a health range and they should be spending 30 to 60 minutes most days involved in moderate physical activity.

The guidelines also note that sexual activity is low risk for patients with no symptoms and annual flu vaccines are encouraged to prevent heart attacks or premature death— especially among elderly patients.

Additionally, counseling is encouraged for patients with depression, anxiety, or stress, as people with CAD are at double the risk of mood and anxiety disorders compared to those without — cognitive behavioral therapy is also highlighted as a method to helping patients achieve healthier lifestyles. Updated guidelines also recommended referring patients to exercise-based cardiac rehabilitation and receive assistance from a multidisciplinary team after an acute event or if the patient is morbidly obese.

Statins are recommended in all patients with chronic coronary syndromes and anti-thrombotic drugs in high-risk patients, while drugs such as angiotensin-converting enzyme inhibitors for specific patient populations.

The updated guidelines also highlight the use of revascularization to open blocked arteries in certain patients, including those at high risk of poor outcomes and those whose symptoms are not controlled through medications and lifestyle.

A release from the ESC also outlined 6 of the most frequent encountered clinical scenarios that can lead to a diagnosis of chronic coronary syndromes due to significant advancements since the last guidelines were published. These include patients with suspected CAD and stable chest pain or shortness of breath, patients without symptoms or with stable symptoms less than one year after an acute coronary syndrome or with recent revascularization, patients with and without symptoms more than one year after initial diagnosis or revascularization, patients with new onset of heart failure or left ventricular dysfunction and suspected CAD, those with chest pain and suspected vasospastic or microvascular disease, and asymptomatic patients in whom CAD is detected at screening.

The “2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes,” are published online in the European Heart Journal.