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Hypoglycemia In Diabetes Mellitus As A Coronary Artery Disease Risk Factor In Patients At Elevated Vascular Risk

Hypoglycemia In Diabetes Mellitus As A Coronary Artery Disease Risk Factor In Patients At Elevated Vascular Risk

The Journal of Clinical Endocrinology & Metabolism Hypoglycemia in Diabetes Mellitus as a Coronary Artery Disease Risk Factor in Patients at Elevated Vascular Risk Division of General Internal Medicine (A.L., S.A.B., V.A.T., B.P., W.H., S.J.A., D.J.W., J.B.M.), Massachusetts General Hospital, Boston, Massachusetts 02114-2698 Harvard Medical School (A.L., S.A.B., V.A.T., S.J.A., J.B.M.), Boston, Massachusetts 02115 Search for other works by this author on: Division of General Internal Medicine (A.L., S.A.B., V.A.T., B.P., W.H., S.J.A., D.J.W., J.B.M.), Massachusetts General Hospital, Boston, Massachusetts 02114-2698 Harvard Medical School (A.L., S.A.B., V.A.T., S.J.A., J.B.M.), Boston, Massachusetts 02115 Diabetes Center (S.A.B., D.J.W.), Massachusetts General Hospital, Boston, Massachusetts 02114 Search for other works by this author on: Division of General Internal Medicine (A.L., S.A.B., V.A.T., B.P., W.H., S.J.A., D.J.W., J.B.M.), Massachusetts General Hospital, Boston, Massachusetts 02114-2698 Harvard Medical School (A.L., S.A.B., V.A.T., S.J.A., J.B.M.), Boston, Massachusetts 02115 Search for other works by this author on: Division of General Internal Medicine (A.L., S.A.B., V.A.T., B.P., W.H., S.J.A., D.J.W., J.B.M.), Massachusetts General Hospital, Boston, Massachusetts 02114-2698 Search for other works by this author on: Division of General Internal Medicine (A.L., S.A.B., V.A.T., B.P., W.H., S.J.A., D.J.W., J.B.M.), Massachusetts General Hospital, Boston, Massachusetts 02114-2698 Search for other works by this author on: Division of General Internal Medicine (A.L., S.A.B., V.A.T., B.P., W.H., S.J.A., D.J.W., J.B.M.), Massachusetts General Hospital, Boston, Massachusetts 02114-2698 Harvard Medical School (A.L., S.A.B., V.A.T., S.J.A., J.B.M.), Boston, Massachus Continue reading >>

Diabetes Mellitus: A Major Risk Factor For Cardiovascular Disease

Diabetes Mellitus: A Major Risk Factor For Cardiovascular Disease

Abundant evidence shows that patients with type 1 diabetes or type 2 diabetes are at high risk for several cardiovascular disorders: coronary heart disease, stroke, peripheral arterial disease, cardiomyopathy, and congestive heart failure. Cardiovascular complications are now the leading causes of diabetes-related morbidity and mortality. The public health impact of cardiovascular disease (CVD) in patients with diabetes is already enormous and is increasing. Several explanations are behind this increase. First, the incidence of diabetes rises with advancing age, and the number of older people in the United States is growing rapidly. Second, insulin treatment for persons with type 1 diabetes has prolonged their lives significantly, and with each year of additional life comes an increased risk for CVD complications. Third, type 2 diabetes occurs at an earlier age in obese and overweight persons, and the prevalence of obesity is rising in the United States. The risk for diabetes in overweight persons is heightened by physical inactivity; unfortunately, the majority of Americans engage in little regular or sustained physical activity. Fourth, the populations that are particularly susceptible to diabetes—African Americans, Hispanics, Native Americans, Pacific Islanders, and Asians—are growing in this country. Fifth, improved medical care, particularly when extended to susceptible populations, will bring an increasing number of patients with type 2 diabetes into the medical care system. All of these factors will lead to an absolute increase in the number of patients who will require medical intervention to prevent the complications of diabetes. Diabetes has long been recognized to be an independent risk factor for CVD. Prospective studies, such as the Framingham, Honolulu Continue reading >>

The Pathophysiology Of Cardiovascular Disease And Diabetes: Beyond Blood Pressure And Lipids

The Pathophysiology Of Cardiovascular Disease And Diabetes: Beyond Blood Pressure And Lipids

In Brief The pathophysiology of the link between diabetes and cardiovascular disease (CVD) is complex and multifactorial. Understanding these profound mechanisms of disease can help clinicians identify and treat CVD in patients with diabetes, as well as help patients prevent these potentially devastating complications. This article reviews the biological basis of the link between diabetes and CVD, from defects in the vasculature to the cellular and molecular mechanisms specific to insulin-resistant states and hyperglycemia. It concludes with a discussion of heart failure in diabetes, a clinical entity that demonstrates many of the mechanisms discussed. Diabetes is a prime risk factor for cardiovascular disease (CVD). Vascular disorders include retinopathy and nephropathy, peripheral vascular disease (PVD), stroke, and coronary artery disease (CAD). Diabetes also affects the heart muscle, causing both systolic and diastolic heart failure. The etiology of this excess cardiovascular morbidity and mortality is not completely clear. Evidence suggests that although hyperglycemia, the hallmark of diabetes, contributes to myocardial damage after ischemic events, it is clearly not the only factor, because both pre-diabetes and the presence of the metabolic syndrome, even in normoglycemic patients, increase the risk of most types of CVD.1–4 In 2002, a survey of people in the United States with diagnosed diabetes found that, surprisingly, 68% of patients did not consider themselves at risk for heart attack or stroke.5 In addition, only about half of patients surveyed reported that their health care providers discussed the high risk of CVD in diabetes and what steps they could take to reduce that risk.5 Fortunately, we are now making the link. Health care providers are now focuse Continue reading >>

Coronary Artery Disease And Diabetes Mellitus

Coronary Artery Disease And Diabetes Mellitus

Coronary artery disease and diabetes mellitus Doron Aronson , MD* and Elazer R. Edelman , MD, PhD *Department of Cardiology, Rambam Medical Center and the Rappaport Research Institute, Technion, Israel Institute of Technology, Haifa, Israel Institute for Medical Science and Engineering, Massachusetts Institute of Technology, and Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School *Department of Cardiology, Rambam Medical Center and the Rappaport Research Institute, Technion, Israel Institute of Technology, Haifa, Israel Institute for Medical Science and Engineering, Massachusetts Institute of Technology, and Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School The publisher's final edited version of this article is available at Cardiol Clin This article has been republished " Coronary Artery Disease and Diabetes Mellitus. " in Heart Fail Clin, volume 12 onpage117. See other articles in PMC that cite the published article. Coronary artery disease (CAD) is a major determinant of the long-term prognosis among patients with diabetes mellitus (DM). DM is associated with a 2 to 4-fold increased mortality risk from heart disease. Furthermore, in patients with DM there is an increased mortality after MI, and worse overall prognosis with CAD. Near-normal glycemic control for a median of 3.5 to 5 years does not reduce cardiovascular events. Thus, the general goal of HbA1c <7% appears reasonable for the majority of patients. Iatrogenic hypoglycemia is the limiting factor in the glycemic management of diabetes, and is an independent cause of excess morbidity and mortality. Statins are effective in reducing major coronary events, stroke, and the need for coronary revascularization. Sele Continue reading >>

Screening For Asymptomatic Coronary Artery Disease In Patients With Type 2 Diabetes Mellitus

Screening For Asymptomatic Coronary Artery Disease In Patients With Type 2 Diabetes Mellitus

Screening for asymptomatic coronary artery disease in patients with type 2 diabetes mellitus 1Instituto do Corao do Hospital das Clnicas da Faculdade de Medicina da Universidade de So Paulo (InCor/HC-FMUSP), Unidade de Corao e Diabetes e Departamento de Radiologia, So Paulo, SP, Brasil Diabetes is a very frequent disease and it is estimated that its prevalence will continuously increase during the next two decades. The arteriosclerotic process in diabetic patients progresses earlier and more diffusely, and it is more accelerated in the diabetic patient than in the overall population. In diabetic subjects, acute myocardial infarction (AMI) and stroke are the leading causes of death, but the presence of arterial disease is not always detected before the development of the acute arterial event. Several times, AMI is asymptomatic or present nonspecific symptoms, and it is the initial form of presentation of coronary artery disease causing an important delay in initiating cardiovascular treatment in these patients. The purpose of this review article is to discuss how to screen and early diagnose the presence of coronary artery disease in asymptomatic diabetic patients, based on new available diagnostic resources. Currently, the most recommended technique used for screening coronary artery disease in these patients is myocardial perfusion scintigraphy or stress echocardiography because of greater sensitivity and specificity in relation to the exercise test. However, technological advances have enabled the development of new imaging diagnostic methods that are less invasive than conventional coronary angiography, and which gradually gain importance in the diagnosis of coronary artery disease as they show higher effectiveness with lower invasiveness and risk. Arch Endocrinol M Continue reading >>

Prevalence Of And Risk Factors For Coronary Heart Disease In Diabetes Mellitus

Prevalence Of And Risk Factors For Coronary Heart Disease In Diabetes Mellitus

INTRODUCTION Heart disease, particularly coronary heart disease (CHD) is a major cause of morbidity and mortality among patients with diabetes mellitus [1]. The epidemiology of and risk factors for CHD and the frequency of silent myocardial ischemia in patients with diabetes will be reviewed here. Therapeutic issues are discussed separately. (See "Treatment of acute myocardial infarction in diabetes mellitus" and "Glycemic control for acute myocardial infarction in patients with and without diabetes mellitus" and "Coronary artery revascularization in patients with diabetes mellitus and multivessel coronary artery disease".) PREVALENCE Compared to individuals without diabetes, those with diabetes have a higher prevalence of coronary heart disease (CHD), a greater extent of coronary ischemia, and are more likely to have a myocardial infarction (MI) and silent myocardial ischemia. Diabetes as a CHD equivalent — The National Cholesterol Education Program report from the United States and guidelines from Europe consider type 2 diabetes to be a CHD equivalent, thereby elevating it to the highest risk category [2,3]. This classification was based in part upon the observation that patients with type 2 diabetes without a prior MI (mean age 58) were at the same risk for MI (20 and 19 percent, respectively) and coronary mortality (15 versus 16 percent) as patients without diabetes who had a prior MI (mean age 56) [4]. Similar findings have been noted in other studies. (See 'Myocardial infarction' below and "Overview of established risk factors for cardiovascular disease", section on 'Diabetes mellitus' and "Management of low density lipoprotein cholesterol (LDL-C) in secondary prevention of cardiovascular disease".) The importance of the association between diabetes and CHD can Continue reading >>

Type 1 Diabetes And Coronary Artery Disease

Type 1 Diabetes And Coronary Artery Disease

ACS, acute coronary syndrome ADA, American Diabetes Association AHA, American Hearth Association ApoA-IV, Apolipoprotein A-IV CAC, coronary artery calcification CAD, coronary artery disease CHD, coronary heart disease CVD, cardiovascular disease DCCT, Diabetes Control and Complications Trial ECG, electrocardiogram EDC, Epidemiology of Diabetes Complications EDIC, Epidemiology of Diabetes Interventions and Complications eGDR, estimated glucose disposal rate IL, interleukin IMT, intima-media thickening MI, myocardial infarction SMR, standardized mortality ratio TNF, tumor necrosis factor WESDR, Wisconsin Epidemiologic Study of Diabetic Retinopathy Although the increased risk of premature heart disease in type 1 diabetes has been recognized for some time, the underlying pathogenesis is still poorly understood. The most likely factor, a priori, to account for this increased risk is hyperglycemia. However, despite recent evidence from the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) study that prior intensive glycemic control reduces cardiovascular disease (CVD), the epidemiologic association between glycemia and coronary heart disease (CHD) is surprisingly weak. This paradox is a focus of the current review, which also evaluates other major determinants of coronary artery disease (CAD) in type 1 diabetes, including the roles of insulin resistance, cytokines, inflammatory biomarkers, and, briefly, genetic factors. Finally, the clinical implications of this information are discussed. THE MAGNITUDE OF THE PROBLEM— A high occurrence of, and mortality from, CHD in type 1 diabetes has been documented since the late 1970s (1,2). A 1984 registry reported a 10-fold or greater CHD mortality compared with that expect Continue reading >>

Evolving Natural History Of Coronary Artery Disease In Diabetes Mellitus

Evolving Natural History Of Coronary Artery Disease In Diabetes Mellitus

Evolving natural history of coronary artery disease in diabetes mellitus Krolewski, Andrzej S ; Warram, James H ; Valsania, Paola ; Martin, Blaise C ; Laffel, Lori M B ; Christlieb, A Richard (1991). Evolving natural history of coronary artery disease in diabetes mellitus. American Journal of Medicine, 90(2A):56S-61S. White diabetic patients are at high risk of developing coronary artery disease (CAD). The natural history of CAD in insulin-dependent (ID) and noninsulin-dependent (NID) diabetes mellitus (DM) is reviewed to gain insight into the mechanisms responsible for the development of premature or accelerated atherosclerosis in diabetic patients. In both IDDM and NIDDM, the risk of CAD increases with lengthening duration of diabetes; the risk, however, does not grow as a constant multiple of the nondiabetic risk of CAD, suggesting that the cumulative exposure to diabetes plays a significant role as a risk factor for CAD only in a subset of patients. This is consistent with the hypothesis that the diabetic milieu has an impact on the progression of atherosclerotic lesions but not on their initiation. This hypothesis is corroborated further by the observation that CAD does not occur in diabetic patients in populations with a low risk of CAD among nondiabetic patients. The component of the diabetic milieu responsible for promotion of atherosclerotic lesions is unknown. There is evidence, however, of a direct or indirect role of hyperinsulinemia in this process. White diabetic patients are at high risk of developing coronary artery disease (CAD). The natural history of CAD in insulin-dependent (ID) and noninsulin-dependent (NID) diabetes mellitus (DM) is reviewed to gain insight into the mechanisms responsible for the development of premature or accelerated atheroscler Continue reading >>

Dspace@mit: Coronary Artery Disease And Diabetes Mellitus

[email protected]: Coronary Artery Disease And Diabetes Mellitus

Coronary Artery Disease and Diabetes Mellitus Research and Teaching Output of the MIT Community JavaScript is disabled for your browser. Some features of this site may not work without it. Coronary Artery Disease and Diabetes Mellitus Department:Harvard University--MIT Division of Health Sciences and Technology; Institute for Medical Engineering and Science Coronary artery disease (CAD) is a major determinant of the long-term prognosis among patients with diabetes mellitus (DM). DM is associated with a 2 to 4-fold increased mortality risk from heart disease. Furthermore, in patients with DM there is an increased mortality after MI, and worse overall prognosis with CAD. Near-normal glycemic control for a median of 3.5 to 5 years does not reduce cardiovascular events. Thus, the general goal of HbA1c <7% appears reasonable for the majority of patients. Iatrogenic hypoglycemia is the limiting factor in the glycemic management of diabetes, and is an independent cause of excess morbidity and mortality. Statins are effective in reducing major coronary events, stroke, and the need for coronary revascularization. Citation:Aronson, Doron, and Elazer R. Edelman. Coronary Artery Disease and Diabetes Mellitus. Cardiology Clinics 32, no. 3 (August 2014): 43955. Continue reading >>

Diabetes And Coronary Heart Disease: A Risk Factor For The Global Epidemic

Diabetes And Coronary Heart Disease: A Risk Factor For The Global Epidemic

International Journal of Hypertension Volume 2012 (2012), Article ID 697240, 7 pages 1Division of Endocrinology, Department of Medicine, Loyola University Medical Center, 2160 South First Avenue, Fahey Bldg, Maywood, IL 60153, USA 2Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA 3Cardiovascular and Thoracic Surgery, University of Illinois at Chicago and Vanguard Weiss Memorial Hospital, 4646 North Marine Drive, Chicago, IL 60640, USA Academic Editor: Eoin O'Brien Copyright © 2012 Maguy Chiha et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Cardiovascular disease remains a leading cause of death in the United States and the world. In this we will paper focus on type 2 diabetes mellitus as a risk factor for coronary heart disease, review the mechanisms of atherogenesis in diabetics, the impact of hypertension and the treatment goals in diabetics, the guidelines for screening, and review the epidemiologic consequences of diabetes and heart disease on a global scale. The underlying premise to consider diabetes a cardiovascular disease equivalent will be explored as well as the recommendations for screening and cardiac testing for asymptomatic diabetic patients. 1. Introduction Cardiovascular disease is currently responsible for 30% of all deaths worldwide with most of the burden now occurring in developing countries [1]. After a peak around 1968, death from coronary heart disease (CHD) has declined significantly in the United States [2]. Based on a statistical mortality model previously validated in Europe, N Continue reading >>

Coronary Artery Disease And Diabetes Mellitus - Sciencedirect

Coronary Artery Disease And Diabetes Mellitus - Sciencedirect

Volume 11, Issue 4 , August 2016, Pages 330-338 Coronary artery disease and diabetes mellitus Author links open overlay panel Mansour M.Al-NozhaFACCa Diabetes mellitus (DM) and coronary artery disease (CAD) are closely related. DM is a risk factor for CAD, but it is also equivalent to established CAD. The prevalence of DM and CAD is growing primarily due to the rising prevalence of obesity. The rapidly changing life style, especially in developing countries, plays major role in the occurrence of these diseases. We performed a literature review to summarize and explore the relationship between CAD and DM with a special focus on Arab countries in terms of risk factors and prevalence. We suggest future directions to prevent escalation in the incidence of DM and CAD in Arab countries. An important part of any preventive program for CAD should include clear prevention strategies for DM and other associated metabolic risk factors, such as obesity. Preventive measures, such as physical exercise in high-risk groups, at the population level should be encouraged. Continue reading >>

Detection Of Silent Coronary Artery Disease In Asymptomatic Patients With Type 2 Diabetes Mellitus

Detection Of Silent Coronary Artery Disease In Asymptomatic Patients With Type 2 Diabetes Mellitus

Diabetes mellitus is an important risk factor for cardiovascular disease. Moreover, cardiovascular diseases are the leading causes for morbidity and mortality in patients with type 2 diabetes mellitus. The high mortality rate is partly due to the diabetic state per se, above and beyond the clustering of other risk factors such as hypertension, dyslipidemia, and obesity. Over the last decade, the overall mortality from cardiovascular disease in the general population has decreased by about 20%. In contrast, mortality in patients with diabetes has increased with a similar percentage.1 As mentioned above, cardiovascular events account for the majority of the deaths. Diabetes is considered a 'coronary artery disease (CAD) equivalent because patients with diabetes without known CAD have a similar cardiac event rate to patients without diabetes who had a prior myocardial infarction (MI).2 In the US, the direct medical cost of diabetes mellitus to society is about US$92 billion per year. Most of these costs are due to cardiovascular complications of diabetes. The conundrum of CAD in conjunction with type 2 diabetes is that it is often silent and when it becomes clinically manifest the disease is often in an advanced stage.3,4 Thus, there is justification to consider appropriate means of screening for CAD in asymptomatic patients with diabetes in order to detect the disease before it strikes. In 1998, the American Diabetes Association (ADA) proposed guidelines for screening of asymptomatic patients with diabetes5 (see Table 1). It should be realized that these guidelines represented the best medical judgment of an expert panel and were not based on evidence in the literature. For example, no credible data existed on the prevalence of silent CAD in asymptomatic diabetic patient Continue reading >>

Coronary Artery Disease In People With Diabetes: Diagnostic And Risk Factor Evaluation

Coronary Artery Disease In People With Diabetes: Diagnostic And Risk Factor Evaluation

CLINICAL DIABETES VOL. 17 NO. 2 1999 These pages are best viewed with Netscape version 3.0 or higher or Internet Explorer version 3.0 or higher. When viewed with other browsers, some characters or attributes may not be rendered correctly. FEATURE ARTICLE James H. Caldwell, MD IN BRIEF People with diabetes are at high risk from coronary artery disease (CAD), tend to present late, and have silent ischemia. Early detection and intervention may improve survival. How to identify these patients is the topic of this review, which will discuss cardiac stress testing in diabetic patients with and without known CAD. The authors discuss who should be tested and review the modalities available for detection of CAD and for risk stratification. CORONARY ARTERY DISEASE AND DIABETES Cardiovascular disease is the leading cause of death among people with type 1 and type 2 diabetes. Coronary artery disease (CAD) is the cause of death in more than half of all diabetic patients, and many are debilitated by symptoms of congestive heart failure or angina. Patients with diabetes but without other conventional risk factors for atherosclerosis have a risk of death from CAD 2– 4 times that of age-matched controls.1– 4 Those with type 2 diabetes commonly have other associated risk factors, such as hypertension or hyperlipidemia, thus further increasing their cardiovascular risk. Women with diabetes are at increased risk, with a risk of cardiovascular death up to 7.5 times that of women without diabetes. Diabetic women do not have the premenopausal benefit seen in the general female population.2,3,5 Individuals with diabetes and CAD fare worse than do other pati Continue reading >>

Management Of Coronary Artery Disease:

Management Of Coronary Artery Disease:

legend]CAD = coronary artery disease; CABG = coronary artery bypass graft; MI = myocardial infarction. Metabolic abnormalities associated with DM Insulin resistance This metabolic syndrome, first described by Reaven, has been proposed as a unifying concept in an attempt to explain the different abnormalities frequently observed in patients with non-insulin-requiring DM (NIRDM) (48,49) (48,49) . It regroups hyperinsulinemia and several cardiovascular risk factors for CAD, including abnormal lipid profile, impaired glucose tolerance, hypertension and upper-body obesity (48,49) (48,49) . Increased plasminogen activator inhibitor-1 (PAI-1), reduced vasodilatory response to acetylcholine and the presence of microalbuminuria have also been described as part of this syndrome (50) . The effect of hyperinsulinemia on the occurrence of CAD has been studied in various large prospective studies, but as yet, no unequivocal relationship has been established [51] [52] [53] [54] . A meta-analysis done by Ruige et al. (53) , regrouping data from 12 prospective studies evaluating this association, found that hyperinsulinemia was a weak risk indicator for CAD and that the relationship was influenced by patients' ethnic background and the type of insulin assay involved in these studies. Many cross-sectional studies have indicated that insulin resistance is associated with ultrasonographically or angiographically assessed atherosclerosis even in the absence of other risk factors [55] [56] [57] [58] . However, there is still controversy about the mechanisms by which the insulin resistance syndrome appears to induce, or at least enhance, atherogenesis. This syndrome may be related to common cardiovascular risk factors or may be directly accelerated by hyperinsulinemia (44,50,52,59) (44,50,52 Continue reading >>

Effect Of Screening For Coronary Artery Disease Using Ct Angiography On Mortality And Cardiac Events In High-risk Patients With Diabetesthe Factor-64 Randomized Clinical Trial

Effect Of Screening For Coronary Artery Disease Using Ct Angiography On Mortality And Cardiac Events In High-risk Patients With Diabetesthe Factor-64 Randomized Clinical Trial

Wolk MJ, Bailey SR, Doherty JU, et al; American College of Cardiology Foundation Appropriate Use Criteria Task Force. ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.J Am Coll Cardiol. 2014;63(4):380-406. PubMed Google Scholar Crossref Mark DB, Berman DS, Budoff MJ, et al; American College of Cardiology Foundation Task Force on Expert Consensus Documents. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents.J Am Coll Cardiol. 2010;55(23):2663-2699. PubMed Google Scholar Crossref Fihn SD, Gardin JM, Abrams J, et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; American College of Physicians; American Association for Thoracic Surgery; Preventive Cardiovascular Nurses Association; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and Continue reading >>

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