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Cholesterol
Primary Goal:
LDL-C<100 mg/dL
If triglycerides are >
200 mg/dL, non –
HDL-C should be <130 mg/dL
Intensive cholesterol-lowering therapy can
significantly reduce the risk of major coronary
events, strokes and total mortality.
LDL-C should be <100mg/dL
Further reduction of LDL-C to <70 mg/dL is
reasonable.
If baseline LDL-C is >
100/dL, initiate LDL-
lowering drug therapy.
If on-treatment LDL-C is >100 mg/dL, intensify
LDL-lowering therapy (may LDL-lowering drug
combination).
If triglycerides are >200 mg/dL, non-HDL-C
should be <130mg/dL and further reduction of non-
HDL-C to <100mg/dL is reasonable.
If triglycerides are >
500mg/dL, therapeutic options
to prevent pancreatitis are fibrate or niacin before
LDL-lowering therapy; and treat LDL-C to goal
after triglyceride-lowering therapy.
Refer to NCEP III guidelines for details
The treatment of elevated LDL-C involves
therapeutic lifestyle changes (TLC) and Drug
therapy.
Essential features of TLC are:
Reduced intake of saturated fats (<7% of
total calories) and cholesterol (<200
mg/day)
Increased intake of soluble fiber
>10g/day and plant stanols/sterols
(2g/day)
Increase consumption of omega-3 fatty
acids in the form of fish or in caspsule
form (1g/d).
Weight reduction/management
Increased physical activity
HMG CoA reductase inhibitors (statins)
Diabetes
Goal:
HbA1c <7%
Screen all CAD patients for diabetes: type 1 DM increases CAD risk three-to-ten fold
Type 2 DM increases CAD risk two fold in men and four in women.
Initiate lifestyle and pharmacotherapy to achieve near-normal HbA1c.
Begin vigorous modification of other risk factors (e.g., physical activity, weight management, blood
pressure control, and cholesterol management as recommended above).
Coordinate diabetic care with patient’s primary care physician or endocrinologist.
Refer to the Clinical Practice Guideline for Diabetes Care.
Physical Activity
Goal:
At least 30 minutes
7days/week
(minimum 5 days)
Exercise training improves exercise tolerance, symptoms, psychological well-being, lipid profiles and
cardiac outcomes.
To guide exercise prescription, assess risk preferable with exercise tolerance test.
For all patient , encourage of 30-60 minutes of moderate-intensity aerobic activity, such as brisk
walking, supplemented by an increase in daily lifestyle activities (household work, gardening).
Encourage resistance training 2 days per week
For moderate-to high risk patients, recommend medically supervised “Cardiac Rehab” programs.
Physicians and patients are sometimes concerned about the safety of exercise training in patients with
CAD although there is clearly a very low rate of serious cardiac events during cardiac rehabilitation.
Weight Management
Goal:
BMI 18.5 to 24.9kg/m2
Waist circumference:
Men <40 inches
Women < 35 inches
Assess body mass index and/or waist circumference on each visit and consistently encourage weight
maintenance/reduction through an appropriate balance of physical activity, caloric intake, and formal
behavioral programs when indicated to maintain/achieve a body mass index between 18.5 and 24.9
kg/m2.
If waist circumference is >
35 inches in women and >40 inches in men, initiated lifestyle changes and
consider treatment strategies for metabolic syndrome as indicated.
The initial goal of weight loss therapy should be to reduce body weight by approximately 10% from
baseline. With success, further weight loss can bet attempted if indicated through further assessment.
gardening).
Influenza Vaccine
Patients with cardiovascular disease should have an influenza vaccination annually.
Education
Goal:
Improve patient
Knowledge &
Enhanced outcome
• Assess patients’ baseline understanding.
Elicit their desire for information.
Use ancillary personal and professional patient education
programs.
Involve family Members.
Invest time to improve functional capacity and survival.
Incorporate patient specific information including prognosis,
treatment plan, physical activity including limitations,
resumption of occupation and sexual activities.
Emphasize risk factor reductions.
Discuss accessing the emergency medical system.
Develop action plans for aspirin and sublingual nitroglycerin
including any contraindications.
Category I risk factors
Identify and treat aggressively
Hypertension
Smoking
Diabetes
Sedentary lifestyle
Hyperlipidemia
Obesity
Category II risk factors
Menopausal complications
Obesity
Stress
Depression
This table of suggested guidelines has been developed from the AHA/ACC Secondary Prevention for Patients with Coronary and Other Vascular Disease revised 2005 clinical guidelines. It
is intended to provide guidance to practitioners to reduce risks associated with CAD, increase awareness of CAD and to optimize disease management. It contains guidelines only and should never
supersede clinical judgment. The practitioner, in conjunction with the patient or responsible party, should decide whether these or other recommended services should be performed more
frequently, less frequently, or not at all. As with all services provided to Bravo Health Members, the clinical judgment and the discussion around it should be documented in the medical record.
