What is the diagnosis and treatment for heart (cardiac) disease?

From the Guidelines

The management of heart conditions, particularly coronary artery disease, should prioritize evidence-based guidelines to reduce morbidity, mortality, and improve quality of life, as outlined in the 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes 1.

Key Recommendations

• For patients with symptoms of angina and intermediate pre-test probability of CAD, exercise ECG is recommended for the assessment of exercise tolerance, symptoms, arrhythmias, BP response, and event risk in selected patients 1.
• In terms of treatment, long-acting nitrates should be considered as a second-line treatment option when initial therapy with a beta-blocker and/or a non-DHP-CCB is contraindicated, poorly tolerated, or inadequate in controlling angina symptoms 1.
• Additionally, nicorandil, ranolazine, ivabradine, or trimetazidine should be considered as a second-line treatment to reduce angina frequency and improve exercise tolerance in subjects who cannot tolerate, have contraindications to, or whose symptoms are not adequately controlled by beta-blockers, CCBs, and long-acting nitrates 1.

Considerations for Heart Failure

While the primary focus is on coronary artery disease, it's also important to consider the management of heart failure, as outlined in the ACCF and AHA guidelines 1.

• Treatment of stage A heart failure should focus on reducing modifiable risk factors, including management of hypertension and hyperlipidemia 1.
• ACE inhibitors and beta blockers should be used in all patients with stage B or C heart failure who have a reduced ejection fraction 1.
• Patients with stage C heart failure and fluid retention should be treated with diuretics in addition to ACE inhibitors and beta blockers 1.

From the FDA Drug Label

1. 2 Heart Failure In two placebo controlled, 12-week clinical studies compared the addition of lisinopril up to 20 mg daily to digitalis and diuretics alone. The combination of lisinopril, digitalis and diuretics reduced the following signs and symptoms of heart failure: edema, rales, paroxysmal nocturnal dyspnea and jugular venous distention In one of the studies, the combination of lisinopril, digitalis and diuretics reduced orthopnea, presence of third heart sound and the number of patients classified as NYHA Class III and IV; and improved exercise tolerance. A large (over 3,000 patients) survival study, the ATLAS Trial, comparing 2. 5 mg and 35 mg of lisinopril in patients with systolic heart failure, showed that the higher dose of lisinopril had outcomes at least as favorable as the lower dose During baseline-controlled clinical trials, in patients with systolic heart failure receiving digitalis and diuretics, single doses of lisinopril resulted in decreases in pulmonary capillary wedge pressure, systemic vascular resistance and blood pressure accompanied by an increase in cardiac output and no change in heart rate.

Lisinopril is used to treat heart failure by reducing signs and symptoms such as:

• Edema
• Rales
• Paroxysmal nocturnal dyspnea
• Jugular venous distention
• Orthopnea
• Presence of third heart sound It also improves exercise tolerance and reduces the number of patients classified as NYHA Class III and IV 2.

From the Research

Heart Health and Cardiovascular Disease

• The heart is a vital organ that requires careful management to prevent cardiovascular disease, with various studies highlighting the importance of controlling risk factors such as hypercholesterolemia and arterial hypertension 3, 4, 5, 6, 7.
• Research has shown that fixed combinations of drugs, such as lisinopril, amlodipine, and rosuvastatin, can be effective in controlling these risk factors and reducing the risk of cardiovascular complications 3, 6, 7.

Treatment Options

• The use of amlodipine and atorvastatin in combination has been shown to be effective in reducing blood pressure and low-density lipoprotein (LDL) cholesterol levels in patients with coronary heart disease 4, 5.
• The combination of lisinopril and amlodipine, in conjunction with rosuvastatin, has been found to be safe and effective in lowering blood pressure and improving lipid profiles in patients with hypertensive disease and coronary heart disease 6, 7.

Efficacy and Safety

• Studies have demonstrated that these combination therapies can achieve significant reductions in blood pressure and LDL cholesterol levels, with a high percentage of patients achieving target levels 4, 6, 7.
• The safety profiles of these combination therapies have been found to be favorable, with minimal adverse events reported 6, 7.