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Feature Article

Optimal medical management of coronary artery disease

Bryan Yan, Andrew Ajani

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Abstract

Coronary artery disease is the largest single cause of death in Australia. GPs have a key role in providing long term management and support to patients who have the disease and to those who are at risk of developing it.

Key Points

  • The goals of management for coronary artery disease are two-fold: to reduce the risk of death and myocardial infarction, and to reduce symptoms of angina and the occurrence of ischaemia.
  • All patients with coronary artery disease should be screened for diabetes, which is often unmasked during a presentation with an acute coronary syndrome. All diabetic patients with proteinuria should be treated with an ACE inhibitor.
  • Antiplatelet agents have unequivocal benefits in coronary artery disease. Unless contraindicated, aspirin should be used indefinitely by most patients who have known cardiovascular disease.
  • ACE inhibition should be considered in all coronary artery disease patients.
  • Patient education is often neglected in the management of patients with coronary artery disease. Explanations about recognising symptoms that can be suggestive of acute myocardial infarction are particularly important.

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