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Optimal Medical Therapy for Stable Ischemic Heart Disease in 2024: Focus on Blood Pressure and Lipids
This article summarizes the pathophysiology, supporting evidence, and treatment recommendations for management of hypertension and dyslipidemia among patients with manifest ischemic heart disease and points to future research and unmet clinical needs.PMID:38548456 | DOI:10.1016/j.mcna.2023.12.005 (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - March 28, 2024 Category: General Medicine Authors: Timothy Abrahams Stephen J Nicholls Adam J Nelson Source Type: research

Optimal Medical Therapy for Stable Ischemic Heart Disease: Focus on Anti-anginal Therapy
Med Clin North Am. 2024 May;108(3):455-468. doi: 10.1016/j.mcna.2023.12.006. Epub 2024 Jan 16.ABSTRACTChronic coronary disease (CCD) is a major cause of morbidity and mortality worldwide. The most common symptom of CCD is exertional angina pectoris, a discomfort in the chest that commonly occurs during activities of daily life. Patients are dismayed by recurring episodes of angina and seek medical help in preventing or minimizing episodes. Angina occurs when the coronary arteries are unable to supply sufficient blood flow to the cardiac muscle to meet the metabolic needs of the left ventricular myocardium. While lifestyle ...
Source: The Medical Clinics of North America - March 28, 2024 Category: General Medicine Authors: Brett M Montelaro Rand Ibrahim Marc Thames Puja K Mehta Source Type: research

A New Age for Secondary Prevention: Optimal Medical Therapy for Stable Ischemic Heart Disease Among Patients with Diabetes and/or Obesity
Med Clin North Am. 2024 May;108(3):469-487. doi: 10.1016/j.mcna.2023.11.003. Epub 2023 Dec 21.ABSTRACTPatients with type 2 diabetes and/or obesity and established cardiovascular disease are at increased risk for recurrent cardiovascular events. The indications of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors have been expanded in the last decade due to benefit in cardiovascular outcome trials and are now considered guideline-recommended therapy for patients with type 2 diabetes and cardiovascular disease. Emerging data have begun to suggest that GLP-1RAs can decrease maj...
Source: The Medical Clinics of North America - March 28, 2024 Category: General Medicine Authors: Nkiru Osude Neha J Pagidipati Source Type: research

Optimal Medical Therapy for Chronic Coronary Disease in 2024: Focus on Antithrombotic Therapy
Med Clin North Am. 2024 May;108(3):489-507. doi: 10.1016/j.mcna.2023.11.004. Epub 2023 Dec 27.ABSTRACTAntiplatelet therapy is the cornerstone of the secondary prevention of cardiovascular disease. Aspirin is indicated for all patients with chronic coronary disease to prevent recurrent ischemic events. A more potent antithrombotic therapy-including P2Y12 inhibitor monotherapy, dual antiplatelet therapy, or vascular dose anticoagulation-reduces the risk of ischemic events but also increases bleeding risk. Clinicians must weigh both ischemic risks and bleeding risks when determining an optimal antithrombotic therapy for patie...
Source: The Medical Clinics of North America - March 28, 2024 Category: General Medicine Authors: Parth P Patel Alexander C Fanaroff Source Type: research

Optimal Medical Therapy for Stable Ischemic Heart Disease in 2024: Focus on Exercise and Cardiac Rehabilitation
Med Clin North Am. 2024 May;108(3):509-516. doi: 10.1016/j.mcna.2023.11.005. Epub 2023 Dec 15.ABSTRACTGiven the prevalence of chronic coronary disease, efforts should be made toward risk factor modification. Cardiac rehabilitation is a secondary prevention program consisting of tailored exercise and lifestyle counseling and has been shown to not only reduce cardiovascular morbidity and mortality but also improve quality of life and exercise capacity. Despite the benefits, it remains underutilized. Efforts should be made to increase referral for patients with chronic coronary disease to aid in symptom management and reducti...
Source: The Medical Clinics of North America - March 28, 2024 Category: General Medicine Authors: Sherrie Khadanga Tanesha Beebe-Peat Source Type: research

When to Consider Coronary Revascularization for Stable Coronary Artery Disease
Med Clin North Am. 2024 May;108(3):517-538. doi: 10.1016/j.mcna.2023.11.006. Epub 2023 Dec 18.ABSTRACTRevascularization is an effective adjunct to medical therapy for some patients with chronic coronary disease. Despite numerous randomized trials, there remains significant uncertainty regarding if and how to revascularize many patients. Coronary artery bypass grafting is a class I indication for patients with significant left main stenosis or multivessel disease with ejection fraction ≤ 35%. For other patients, clinicians must carefully consider the potential benefits of symptom improvement and reduction of future myocar...
Source: The Medical Clinics of North America - March 28, 2024 Category: General Medicine Authors: Andrew M Cheng Jacob A Doll Source Type: research

Antiplatelet Therapy for Patients Who Have Undergone Revascularization Within the Past Year: Which Agents and for How Long?
Med Clin North Am. 2024 May;108(3):539-551. doi: 10.1016/j.mcna.2023.12.003. Epub 2024 Jan 9.ABSTRACTDual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is recommended for at least 6 and 12 months following percutaneous coronary intervention with drug-eluting stents among patients with stable ischemic heart disease and acute coronary syndrome, respectively. Additional exposure to antiplatelet therapy reduces ischemic events but also increases bleeding risk. Conversely, shorter durations of DAPT are preferred among those at high bleeding risk. Hence, decisions surrounding duration of DAPT after revasculariza...
Source: The Medical Clinics of North America - March 28, 2024 Category: General Medicine Authors: Khawaja Hassan Akhtar Usman Baber Source Type: research

Medical Decision-Making and Revascularization in Ischemic Cardiomyopathy
Med Clin North Am. 2024 May;108(3):553-566. doi: 10.1016/j.mcna.2023.11.007. Epub 2023 Dec 18.ABSTRACTIschemic cardiomyopathy (ICM) is the most common underlying etiology of heart failure in the United States and is a significant contributor to deaths due to cardiovascular disease worldwide. The diagnosis and management of ICM has advanced significantly over the past few decades, and the evidence for medical therapy in ICM is both compelling and robust. This contrasts with evidence for coronary revascularization, which is more controversial and favors surgical approaches. This review will examine landmark clinical trial re...
Source: The Medical Clinics of North America - March 28, 2024 Category: General Medicine Authors: Alex J Chang Yilin Liang Steven A Hamilton Andrew P Ambrosy Source Type: research

Ischemic Heart Disease in Women
Med Clin North Am. 2024 May;108(3):567-579. doi: 10.1016/j.mcna.2023.11.001. Epub 2023 Dec 23.ABSTRACTThis review synthesizes the current understanding of ischemic heart disease in women, briefly discussing differences in risk factors, presentation, and treatment. We have underscored the unique clinical phenotype of IHD in women with a higher prevalence of ischemia with non-obstructive coronary arteries. Further research is needed to elucidate the complexities of ischemic heart disease in women, understand the discordance between ischemic burden and clinical symptoms, and optimize treatment strategies.PMID:38548464 | DOI:1...
Source: The Medical Clinics of North America - March 28, 2024 Category: General Medicine Authors: Eleonore Grant Monika Sanghavi Source Type: research

Chronic Coronary Disease in Older Adults
Med Clin North Am. 2024 May;108(3):581-594. doi: 10.1016/j.mcna.2023.12.004. Epub 2024 Jan 4.ABSTRACTThe number of older adults age ≥75 with chronic coronary disease (CCD) continues to rise. CCD is a major contributor to morbidity, mortality, and disability in older adults. Older adults are underrepresented in randomized controlled trials of CCD, which limits generalizability to older adults living with multiple chronic conditions and geriatric syndromes. This review discusses the presentation of CCD in older adults, reviews the guideline-directed medical and invasive therapies, and recommends a patient-centric approach ...
Source: The Medical Clinics of North America - March 28, 2024 Category: General Medicine Authors: Alexander P Ambrosini Emily S Fishman Abdulla A Damluji Michael G Nanna Source Type: research

Racial and Ethnic Disparities in the Management of Chronic Coronary Disease
Med Clin North Am. 2024 May;108(3):595-607. doi: 10.1016/j.mcna.2023.11.008. Epub 2023 Dec 19.ABSTRACTChronic coronary disease (CCD) comprises a continuum of conditions that include obstructive and non-obstructive coronary artery disease with or without prior acute coronary syndrome. Racial and ethnic representation disparities are pervasive in CCD guideline-informing clinical trials and evidence-based management. These disparities manifest across the entire spectrum of CCD management, spanning from non-pharmacological lifestyle changes to guideline-directed medical therapy, and cardiac rehabilitation to invasive procedure...
Source: The Medical Clinics of North America - March 28, 2024 Category: General Medicine Authors: Wilson Lay Tang Fatima Rodriguez Source Type: research

Collaborative Care
Med Clin North Am. 2024 May;108(3):xv-xvi. doi: 10.1016/j.mcna.2024.01.001. Epub 2024 Feb 1.NO ABSTRACTPMID:38548467 | DOI:10.1016/j.mcna.2024.01.001 (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - March 28, 2024 Category: General Medicine Authors: Jack Ende Source Type: research

Chronic Coronary Disease
Med Clin North Am. 2024 May;108(3):xvii-xx. doi: 10.1016/j.mcna.2023.12.007. Epub 2024 Jan 5.NO ABSTRACTPMID:38548468 | DOI:10.1016/j.mcna.2023.12.007 (Source: The Medical Clinics of North America)
Source: The Medical Clinics of North America - March 28, 2024 Category: General Medicine Authors: Alexander C Fanaroff John W Hirshfeld Source Type: research

Top-Down and Bottom-Up Mechanisms of Motor Recovery Poststroke
Phys Med Rehabil Clin N Am. 2024 May;35(2):235-257. doi: 10.1016/j.pmr.2023.07.006. Epub 2023 Aug 30.ABSTRACTStroke remains a leading cause of disability. Motor recovery requires the interaction of top-down and bottom-up mechanisms, which reinforce each other. Injury to the brain initiates a biphasic neuroimmune process, which opens a window for spontaneous recovery during which the brain is particularly sensitive to activity. Physical activity during this sensitive period can lead to rapid recovery by potentiating anti-inflammatory and neuroplastic processes. On the other hand, lack of physical activity can lead to early ...
Source: The Medical Clinics of North America - March 21, 2024 Category: General Medicine Authors: Preeti Raghavan Source Type: research

A Review of Poststroke Aphasia Recovery and Treatment Options
Phys Med Rehabil Clin N Am. 2024 May;35(2):419-431. doi: 10.1016/j.pmr.2023.06.010. Epub 2023 Jul 11.ABSTRACTPoststroke aphasia, which impacts expressive and receptive communication, can have detrimental effects on the psychosocial well-being and the quality of life of those affected. Aphasia recovery is multidimensional and can be influenced by several baseline, stroke-related, and treatment-related factors, including preexisting cerebrovascular conditions, stroke size and location, and amount of therapy received. Importantly, aphasia recovery can continue for many years after aphasia onset. Behavioral speech and language...
Source: The Medical Clinics of North America - March 21, 2024 Category: General Medicine Authors: Victoria E Tilton-Bolowsky Argye E Hillis Source Type: research