Secondary Prevention of Coronary Artery Disease

The University of Michigan Health System issued these guidelines for clinical care of adults with coronary artery disease in March 2009, making them recent and directly applicable for physicians. According to the authors of this guideline, “although effective secondary prevention is available, a number of studies have shown that it does not occur for many patients and that only some aspects of secondary prevention are performed for many other patients.” These guidelines were developed, according to the authors, to help physicians achieve secondary prevention measures with patients and include information about smoking cessation, blood pressure control, and weight management.

The recommendations for secondary prevention of CAD cover:

• Smoking cessation (University of Michigan Health System smoking cessation guidelines can be accessed here)

• Use of antiplatelet agents and anticoagulants, beta-blockers, and renin-angiotensin-aldosterone system blockers

• Blood pressure control (The guidelines state that “A general blood pressure (BP) goal of <135/80 is reasonable based on available data. Few studies have targeted or achieved systolic BP below 140 mmHg, so recommendations for systolic BP goals are largely based on extrapolations and expert opinion.”)

• Lipid management (UMHS guidelines on the screening and management of lipids can be accessed here)

• Diabetes management (Click here to access UMHS diabetes treatment and management guidelines)

• Pain control (The guidelines recommend that “At the time of admission for acute coronary syndrome [physicians should] discontinue all COX-2 inhibitors and NSAIDs, EXCEPT aspirin.”)

• Depression screening (UMHS diabetes guidelines on the recognition and treatment of depression are available here)

• Physical activity, weight management, and nutrition

• Immunizations (Go here to access UMHS adult immunization guidelines)

To access the complete guidelines and read the rationale behind each recommendation, click here.