The literature is extracted from the Medical Pulse website —- Diagnosis of Stable Ischemic Heart Disease:Clinical Practice Guidelines (?http://news.medlive.cn/heart/info-progress/show-45277_129.html) According to the new guidelines, lifestyle changes and pharmacotherapy should be the primary interventions for patients with stable ischemic heart disease (IHD ) patients, and the primary focus of interventions for these patients should be to reduce the risk of premature cardiovascular death and nonfatal MI while maintaining activity levels and quality of life. The guidelines include 48 specific recommendations related to primary care physicians and emphasize patient education and management of cardiovascular disease risk factors. An unproven risk reduction program is discussed, using pharmacotherapy to prevent myocardial infarction and death and to relieve angina symptoms, using revascularization to improve survival and symptoms, and patient follow-up. The status of pharmacotherapy as first-line treatment cannot be changed The principal investigator of the Clinical Outcomes Review of Revascularization and Intensive Drug Therapy (COURAGE) trial, Dr. William Boden (Stratton VA Medical Center), noted that the treatment of stable ischemic heart disease is a goal of continuous improvement and that the treatment guidelines used to treat these patients have not been comprehensively revised since 2002. With the publication of COURAGE and Coronary Artery Revascularization in Patients with Type 2 Diabetes (BARI 2D), these trials are thought likely to spur a rewrite of the guidelines, but even then, an update will take at least three years. The new guidelines are very supportive of the importance of pharmacotherapy as first-line treatment for patients with stable IHD. But Boden believes that preventing stable ischemic heart disease should start with lifestyle interventions and eliminating unhealthy behaviors, followed by secondary prevention and pharmacotherapy as the correct sequence of treatment for cardiovascular events. if we are ultimately about reducing death and myocardial infarction, Boden notes, then the best way to achieve these goals online is to make sure we invest heavily in patient education and affirm that We emphasize the importance of lifestyle interventions and secondary prevention. The new guidelines recommend the use of beta-blockers as initial therapy to relieve symptoms in patients with stable IHD. Calcium channel blockers or long-acting nitrates are recommended when beta-blocker use is contraindicated or causes unacceptable side effects or when initial therapy is unsuccessful. Sublingual nitroglycerin or nitroglycerin spray is recommended for immediate relief of angina pectoris. If symptoms persist despite drug therapy, physicians should consider coronary revascularization. Recommendations for patients requiring revascularization Regarding revascularization to improve symptoms, CABG or PCI is recommended for patients with one or more significant impairments (stenosis > 70%). should not undergo PCI if they are unable or unlikely to receive dual antiplatelet therapy. In addition, the guideline recommends CABG or PCI to improve survival in some clinical cases, such as patients with left main coronary stenosis, patients with three major coronary artery lesions, or patients with ischemic ventricular tachycardia due to suspected main coronary stenosis. PCI or CABG is not recommended in patients with stable IHD and concomitant survival with one or more anatomically or functionally insignificant coronary artery disease. Dr. Daniel Simon (University Hospitals Cleveland Case Medical Center) mentioned that there is a growing concern about the indications for PCI, and this has led to some uncertainty about treatment goals. He applauded the new guidelines, particularly the efforts to reduce cardiovascular morbidity and mortality through appropriate hemodynamic reconstruction strategies. As a cardiac interventionalist, he offered some suggestions of his own but not addressed by the clinical guidelines.