Rec­om­men­da­tions

Screen­ing

10.34 In asymp­tomat­ic pa­tients, rou­tine screen­ing for coro­nary artery dis­ease is not rec­om­mend­ed as it does not im­prove out­comes as long as atheroscle­rot­ic car­dio­vas­cu­lar dis­ease risk fac­tors are treat­ed. A

10.35 Con­sid­er in­ves­ti­ga­tions for coro­nary artery dis­ease in the pres­ence of any of the fol­lowing: atyp­i­cal car­diac symp­toms (e.g., unex­plained dys­p­nea, chest dis­com­fort); signs or symp­toms of as­so­ci­at­ed vas­cu­lar dis­ease in­clud­ing carotid bruits, tran­sient is­chemic at­tack, stroke, clau­di­ca­tion, or pe­riph­er­al ar­te­ri­al dis­ease; or elec­tro­car­dio­gram ab­nor­malities (e.g., Q waves). E

Treat­ment

10.36 In pa­tients with known atheroscle­rot­ic car­dio­vas­cu­lar dis­ease, con­sid­er ACE in­hibitor or an­giotensin re­cep­tor block­er ther­a­py to re­duce the risk of car­dio­vas­cu­lar events. B

10.37 In pa­tients with prior my­ocar­dial in­farc­tion, β-‍block­ers should be con­tin­ued for at least 2 years after the event. B

10.38 In pa­tients with type 2 di­a­betes with sta­ble con­ges­tive heart fail­ure, met­formin may be used if es­ti­mat­ed glomeru­lar filtra­tion rate re­mains >30 mL/‍min but should be avoid­ed in un­sta­ble or hos­pi­talized pa­tients with con­ges­tive heart fail­ure. B

10.39 Among pa­tients with type 2 di­a­betes who have es­tab­lished atheroscle­rot­ic car­dio­vas­cu­lar dis­ease, sodi­um–glu­cose co­trans­porter 2 in­hibitors or glucagon-‍like pep­tide 1 re­cep­tor ag­o­nists with demon­strat­ed car­dio­vas­cu­lar dis­ease benefit (Table 9.1) are rec­om­mend­ed as part of the an­ti­hy­per­glycemic reg­i­men. A

10.40 Among pa­tients with atheroscle­rot­ic car­dio­vas­cu­lar dis­ease at high risk of heart fail­ure or in whom heart fail­ure co­ex­ists, sodi­um–glu­cose co­trans­porter 2 in­hibitors are pre­ferred. C