“Air pollution and environmental noise increase the risk of heart attack and stroke, so policies and regulations are needed to minimise both,” said Professor Juhani Knuuti, Chairperson of the guidelines Task Force and director of the Turku PET Centre, Finland. “Patients with chronic coronary syndromes should avoid areas with heavy traffic congestion and may consider wearing a respirator face mask. Air purifiers with high efficiency particulate air filters can be used to reduce indoor pollution.”
These new guidelines are an update to previously published stable coronary artery disease (CAD) ESC guidelines.
“This reflects the fact that CAD can be acute (covered in separate guidelines) or chronic and both are dynamic conditions,” said Professor William Wijns, Chairperson of the guidelines Task Force and professor in interventional cardiology at the Lambe Institute for Translational Medicine. “Therapy is lifelong and aimed at preventing progression of the disease and cardiac events such as heart attacks.”
Furthermore, this new set of guidelines, published in European Heart Journal, put more emphasis on lifestyle changes necessary to make in order to thwart and/or prevent the development of a chronic coronary syndrome.
Examples of these lifestyle changes include refraining from smoking and drinking alcohol, eating a diet rich in vegetables, fruit, and whole grains, and engaging in 30 to 60 minutes of physical activity per day.
Counseling and cognitive behavioral therapy is also advised for CAD patients who experience anxiety, depression or stress, and may also benefit those who are having a hard time transitioning into a healthier lifestyle or maintaining a healthy weight, as is taking appropriate medications.
The updated guidelines also outline the six most frequently encountered clinical scenarios that result in the diagnosis of chronic coronary syndromes. These scenarios involve patients with suspected CAD and stable chest pain (angina) or shortness of breath, patients without symptoms or with stable symptoms less than one year after an acute coronary syndrome or with recent revascularisation, patients with and without symptoms more than one year after initial diagnosis or revascularisation, patients with new onset of heart failure or left ventricular dysfunction and suspected CAD, patients with angina and suspected vasospastic or microvascular disease, and asymptomatic patients in whom CAD is detected at screening.
“Each of these scenarios requires different diagnostic and therapeutic approaches,” Prof Wijns said. “But in general, treatment of a chronic coronary syndrome demands long-lasting healthy habits, medication adherence, and interventions in selected patients.”
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