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CLINICAL STATEMENTS AND GUIDELINES Circulation. 2023;148:e9–e119. DOI: 10.1161/CIR.0000000000001168 August 29, 2023 Virani et al 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Chronic Coronary Disease Guideline 1.6 Abbreviations Abbreviation Meaning/Phrase ACE angiotensin-converting enzyme ACS acute coronary syndrome AF atrial fibrillation ARB angiotensin-receptor blocker ASCVD atherosclerotic cardiovascular disease BMI body mass index BP blood pressure CABG coronary artery bypass grafting CAD coronary artery disease CCB calcium channel blocker CCD chronic coronary disease CHD coronary heart disease CKD chronic kidney disease CMR cardiovascular magnetic resonance COVID-19 coronavirus disease 2019 CR cardiac rehabilitation CVD cardiovascular disease CTA computed tomography angiography CCTA coronary CT angiography DAPT dual antiplatelet therapy DOAC direct oral anticoagulant ECG electrocardiogram eGFR estimated glomerular filtration rate FDA US Food and Drug Administration FH familial hypercholesterolemia FFR fractional flow reserve GDMT guideline-directed management and therapy GLP-1 glucagon-like peptide-1 HDL high-density lipoprotein HF heart failure HIV human immunodeficiency virus iFR instantaneous wave-free ratio INOCA ischemia with nonobstructive coronary artery LDL low-density lipoprotein LV left ventricular LVEF left ventricular ejection fraction MACE major adverse cardiovascular event MBFR myocardial blood flow reserve MPI myocardial perfusion imaging MI myocardial infarction NRT nicotine replacement therapy P2Y12 platelet adenosine diphosphate receptor PET positron emission tomography PCI percutaneous coronary intervention PCSK9 proprotein convertase subtilisin/kexin type 9 PPI proton pump inhibitor Abbreviation Meaning/Phrase QOL quality of life RAASi renin-angiotensin-aldosterone system inhibitor RCT randomized controlled trial SAPT single antiplatelet therapy SCAD spontaneous coronary artery dissection SDOH social determinants of health SGLT2 sodium glucose cotransporter 2 SPECT single-photon emission computed tomography TIA transient ischemic attack 2 EPIDEMIOLOGY AND GENERAL PRINCIPLES CCD is a heterogeneous group of conditions that includes obstructive and nonobstructive CAD with or without previous myocardial infarction (MI) or revascularization, ischemic heart disease diagnosed only by noninvasive testing, and chronic angina syndromes with varying underlying causes. Approximately 20.1 million persons in the United States live with CCD, 11.1 million Americans have chronic stable angina pectoris, and approximately one-quarter (n=200 000) of all MIs in the United States occur among the 8.8 million persons with CCD who have had a previous MI (Table 4).1 Despite an approximate 25% overall relative decline in death from coronary heart disease (CHD) over the past decade, it remains the leading cause of death in the United States and worldwide and is associated with substantial individual, economic, and societal burdens.1 Within the United States (Figures 1 and 2, Table 4) and worldwide (Figure 3), the prevalence of CCD and chronic stable angina vary by age, sex, race, ethnicity, and geographic region, and the role of SDOH in both risk for and outcomes from CCD is increasingly recognized.1 Since the publication of the “2012 ACCF/AHA/ACP/ AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease,”2 not only have health care expenditures for CCD remained high, but also the number and complexity of comorbid conditions and concurrent treatments for those conditions among patients with CCD have increased. For example, older age and chronic kidney disease (CKD) commonly coexist with CCD and independently and together raise unique considerations for diagnosis, risk stratification, and treatment. At the intersection between CCD and atrial fibrillation (AF), new information informs the use of antiplatelet therapy and anticoagulation in patients with CCD and atrial fibrillation. Additionally, as the population ages and both CCD and cancer survival improve, concurrent CCD and cancer more often coexist, and the field of cardio-oncology has emerged to address the challenges of these intersecting chronic conditions. Further, the fields of diabetes and lipid management have evolved rapidly with multiple new therapies (eg, sodium Downloaded from http://ahajournals.org by on October 7, 2026