From the Guidelines
The management of patients with coronary and other atherosclerotic vascular disease should prioritize complete cessation of smoking, blood pressure control, and lipid management, as outlined in the 2011 update from the American Heart Association and American College of Cardiology Foundation 1. To achieve this, several key interventions are recommended:
- For smoking cessation, patients should be asked about tobacco use status at every office visit, advised to quit, and assisted by counseling and development of a plan for quitting that may include pharmacotherapy and/or referral to a smoking cessation program 1.
- For blood pressure control, all patients should be counseled regarding the need for lifestyle modification, and those with blood pressure ≥ 140/90 mm Hg should be treated with blood pressure medication, initially with β-blockers and/or ACE inhibitors, with addition of other drugs as needed to achieve goal blood pressure 1.
- For lipid management, a lipid profile should be established in all patients, and statin therapy should be prescribed in the absence of contraindications or documented adverse effects, with the goal of achieving an LDL-C of < 100 mg/dL, and < 70 mg/dL for very high-risk patients 1. These recommendations are based on the highest quality evidence available, and prioritizing them is crucial for reducing morbidity, mortality, and improving quality of life in patients with coronary and other atherosclerotic vascular disease. Some other guidelines also support the importance of a comprehensive approach to patient care, including the management of physical and psychosocial long-term/late effects in breast cancer survivors 1, and the use of evidence-based research to inform guideline recommendations 1. However, the most recent and highest quality study on the management of patients with coronary and other atherosclerotic vascular disease is the 2011 update from the American Heart Association and American College of Cardiology Foundation 1, which should be prioritized in clinical decision-making.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Guideline for Acute Pain Management
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain 2
- Topical NSAIDs are recommended for non-low back, musculoskeletal injuries 2
- Acetaminophen is well tolerated, but lower doses should be used in patients with advanced hepatic disease, malnutrition, or severe alcohol use disorder 2
- Nonselective NSAIDs are effective but should be used with caution in patients with a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease 2
Efficacy of Acetaminophen for Chronic Pain
- There is little evidence to support the efficacy of acetaminophen treatment in patients with chronic pain conditions 3
- Acetaminophen is often recommended as a first-line analgesic, but its efficacy in many pain conditions is questionable 4
- Ibuprofen is consistently superior to acetaminophen at conventional doses in a range of painful conditions, including acute post-operative pain, dysmenorrhoea, and osteoarthritis 4
Importance of Clinical Reasoning
- Clinical decisions should be based on evidence-based recommendations, but also require clinical reasoning to account for individual patient characteristics and circumstances 5
- Guidelines are key sources of knowledge, but limitations in the extent, quality, generalizability, and transferability of evidence mean that clinicians must still reason through the best choices for an individual patient 5
- Strong recommendations from low certainty evidence can be justified in certain situations, such as life-threatening situations, but require careful consideration and transparency in reporting 6
Considerations for Guideline Development
- Guideline developers should carefully evaluate the evidence and assign a strength to recommendations based on the quality of evidence 6
- Discordant recommendations, where strong recommendations are made based on low certainty evidence, should be clearly justified and transparently reported 6
- Clinicians should be aware of the limitations of guidelines and use clinical reasoning to make informed decisions for individual patients 5