2013 ESC guidelines on the management of stable coronary artery disease

Abstract

UK), Ernst E. van der Wall (Netherlands), Christiaan J.M. Vrints (Belgium).

Cardiovascular Safety, Long‐Term Noncardiovascular Safety, and Efficacy of Sodium–Glucose Cotransporter 2 Inhibitors in Patients With Type 2 Diabetes Mellitus: A Systemic Review and Meta‐Analysis With Trial Sequential Analysis

“…First, these findings well documented the cardiovascular safety of SGLT2 inhibitors and provided strong support for the clinical use of these drugs, either as alternative therapy or as adjuncts to metformin, other oral antiglycemic agents, or insulin 37. Second, our findings strongly supported a new concept that was previously ignored by most cardiologists38: Selective glucose‐lowering treatment with SLGT2 inhibitors—for example, blood pressure‐lowering treatment with the use of renin–angiotensin–aldosterone system inhibitors or β‐blockers, lipid‐lowering therapy with statins or ezetimibe or PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitors, and anticoagulant treatment with acetylsalicylic acid—could significantly improve the cardiovascular outcomes of diabetic patients with established CVD or with high cardiovascular risk 39, 40. Many patients with coronary heart disease have concomitant DM.…”

“…Many patients with coronary heart disease have concomitant DM. Previous guidelines in cardiology did not make a recommendation on the selection of antihyperglycemic drugs in this population 39, 40. However, based on current evidence, antihyperglycemic drugs should be chosen with preference in patients with CVD and type 2 DM, with strong recommendation for use of antidiabetic drugs that improve cardiovascular outcomes, such as SGLT2 inhibitors and several GLP‐1 (glucagon‐like peptide 1) receptor agonists 41, 42.…”

Physical Activity in the Prevention and Treatment of Coronary Artery Disease

“…Thus, current guidelines do not recommend PCI in patients with CAD without proof of myocardial ischemia (>10% of the myocardium) or proof of hemodynamic relevance of the stenosis detected by fractional flow reserve 67. In contrast, physical activity performed on a regular basis has been proved to blunt symptoms, improve myocardial perfusion, and, most important, reduce mortality in patients with CAD/myocardial infarction.…”

Relationship Between β‐Blocker Therapy at Discharge and Clinical Outcomes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

“…Of these, MI referred to symptoms with new electrocardiographic changes (pathologic Q waves, persistent ST‐segment elevation, or ST‐segment depression) as well as cardiac markers at least one value above the 99th percentile of the upper reference limit 14. The identification of heart failure readmission was consistent with the guidelines of the European Society of Cardiology 15. In addition, cardiogenic hospitalization was considered as a hospitalization for cardiovascular cause, including UAP, transient ischemic attack, or revascularization procedure.…”