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Coronary Artery Disease – Treatment Overview

Treatment Overview

The main goals of coronary artery disease (CAD) treatment are to:1

  • relieve symptoms
  • reduce risk factors so as to slow/stop atherosclerosis
  • lower the risk of blood clots forming, which in turn cause heart failure/attack
  • widen blocked arteries
  • prevent other CAD-associated complications

Traditional cardiovascular (CV) risk factors may be more common in people living with HIV (PLWHIV) versus HIV-negative people, and traditional prevention strategies remain valid.2 Lifestyle modifications are recommended to reduce CV risk and may include smoking cessation, dietary changes and weight control, moderation of alcohol intake, and increased exercise, as appropriate.3



Treatment aims for chronic stable angina are to:4

  • improve prognosis by preventing outcomes of angina, such as myocardial infarction (MI) and death
  • minimize or abolish symptoms.

For a flow chart on treatment algorithms for stable angina please see the Management of Stable Angina.4 



One study found that the acute management of acute coronary syndromes (ACS) in PLWHIV can generally be the same as that of HIV-negative patients, but specific secondary prevention measures may alleviate an increased risk of recurrent ACS.5 In a smaller study of HIV-positive patients, revascularization procedures were performed safely with low in-hospital mortality.6



Table 1: A list of drug classes and example medications recommended for the treatment of people with established coronary heart disease (CHD), cerebrovascular disease or peripheral vascular disease.3 



Reproduced with permission from the World Health Organization.


For the treatment of unfavourable lipid profiles in PLWHIV, lipid management compounds are recommended. Please see the Guidelines for the Evaluation and Management of Dyslipidemia in Human Immunodeficiency Virus (HIV)–Infected Adults Receiving Antiretroviral Therapy: Recommendations of the HIV Medicine Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group.7 





References

  1. National Heart Lung and Blood Institute website. Accessed 28 February 2011. 
  2. Baker JV, Lundgren JD. Cardiovascular implications from untreated human immunodeficiency virus infection. Eur Heart J. 2011;32:945–951. 
  3. World Health Organization Prevention of Cardiovascular Disease: Pocket Guidelines for Assessment and Management of Cardiovascular Risk; Part 2: Management of People with Established Coronary Heart Disease, Cerebrovascular Disease or Peripheral Vascular Disease (Secondary Prevention) 
  4. Guidelines on the Management of Stable Angina Pectoris. The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology, 2007. Accessed 18 April 2011.
  5. Boccara F, Mary-Krause M, Teiger E, et al. Acute coronary syndrome in human immunodeficiency virus-infected patients: characteristics and 1 year prognosis. Eur Heart J. 2011;32:41–50. 
  6. Ambrose JA, Gould RB, Kurian DC, et al. Frequency of and outcome of acute coronary syndromes in patients with human immunodeficiency virus infection. Am J Cardiol. 2003;92:301–303. 
  7. Dubé MP, Stein JH, Aberg JA, et al. Guidelines for the Evaluation and Management of Dyslipidemia in Human Immunodeficiency Virus (HIV)-Infected Adults Receiving Antiretroviral Therapy: Recommendations of the HIV Medical Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group. Clin Infect Dis. 2003;37:613–627.