NASH covers a wide spectrum of disease severity

The 2019 guidelines of the European Society of Cardiology (ESC) recognise that chronic coronary diseases may have many different facets.
These are a dynamic process of plaque accumulation and functional changes of coronary circulation that can be modified by lifestyle changes, pharmacological therapies and revascularisation.
Implementation programmes are needed because it has been shown that the outcome of disease may be favourably influenced by the thorough application of clinical recommendations.

Some of the key changes in the updated guidelines are:

  • Revision to focus on chronic coronary syndromes (CCS) instead of stable CAD.
  • The prevalence of CAD in symptomatic populations has decreased leading to lower pre-test probability of disease. This has major impact on the use of diagnostic testing.
  • Imaging has advanced – both anatomy and function are available invasively and non-invasively. The role of CT is increasing.
  • New evidence on intensified antithrombotic therapy.
However, these guidelines have important limitations, especially regarding applicability. It seems they are aimed at rich countries.
Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020;41:407-477.