SIHD Lecture.pdf

Stable Ischemic Heart Disease Genevieve Hale, PharmD, BCPS, BCCP, CPh Associate Professor of Pharmacy Practice Nova Southeastern University College of Pharmacy Integrated Disease Management II [email protected]  Stable Ischemic Heart Disease Ter...

Stable Ischemic Heart Disease Genevieve Hale, PharmD, BCPS, BCCP, CPh Associate Professor of Pharmacy Practice Nova Southeastern University College of Pharmacy Integrated Disease Management II [email protected]  Stable Ischemic Heart Disease Terminology Stable ischemic heart disease (SIHD) is also known as: Chronic coronary disease (CCD) Coronary artery disease (CAD) Coronary heart disease (CHD) Coronary artery atherosclerosis Occurs when there is an inadequate blood supply to the myocardium (heart muscle)  Who Cares? SIHD is the leading cause of death for men and women worldwide! In the United States >20 million adults have CCD In persons 60 to 79 years of age, approximately 22% of men and 13% of women have CHD At 80 years of age this rises to approximately 34% and 22% among men and women, respectively  Risk Factors Non-modifiable Modifiable Age Smoking Genetics/Family history of Hyperlipidemia premature IHD (i.e., onset in a father, brother, or son 150 mg/dL and secondary causes are addressed (i.e., lifestyle) Remember, CAD/stable angina (SIHD) is part of clinical ASCVD per hyperlipidemia guidelines  New Consideration with First-Line: Agents to Prevent CV events (MACE) Colchicine 0.5 mg daily Can be considered to reduce recurrent atherosclerotic cardiovascular disease (ASCVD) events Anti-inflammatory agent Long t1/2, Narrow therapeutic index and prone to drug-drug interactions (CYP 3A4 and p-glycoprotein) Avoid use if eGFR age of 40 years Significant morbidity, mortality, and quality of life impairment Atherosclerosis in the periphery, particularly in the lower limbs (legs) Risk factors Elderly (i.e., > 75 years) Family history of PAD Depression Atherosclerotic risk factors – diabetes, hypertension, hyperlipidemia, smoker CKD/ESKD Microvascular disease (retinopathy, neuropathy, nephropathy)  Symptoms and Complications Can be asymptomatic Claudication Fatigue, discomfort, cramping, or pain of vascular origin in the muscles of the lower extremities that is consistently induced by exercise and consistently relieved by rest (within 10 min) Acute limb ischemia (ALI) Acute ( 70 mg/dL) Cilostazol for claudication Cilostazol improves symptoms and increases walking distance MOA: PDE3 inhibitor which causes vasodilation, reversibly inhibits platelet aggregation and inhibits vascular smooth muscle cell proliferation 100 mg PO BID (discontinue if symptoms do not resolve in 3 months) Side effects: headache, diarrhea, dizziness, palpitations, bleeding Contraindicated in heart failure  Standard Pharmacotherapy Antihypertensive medication Control blood pressure (