Contemporary Management of Patients with Stable Ischemic Heart Disease

The overall goals of therapy for patients with stable ischemic heart disease are to minimize the likelihood of death while maximizing health and function. Initial risk assessment with noninvasive testing is indicated to determine whether invasive evaluation is needed in addition to medical therapy. All patients with stable ischemic heart disease need optimal medical therapy, which includes risk factor management with lifestyle modifications and pharmacologic therapy. First-line pharmacologic therapy is focused on preventing myocardial infarction and death with antiplatelet agents, lipid-lowering therapy, and antihypertensive therapies. In addition, antianginal therapy and anti-ischemic therapy are indicated to alleviate symptoms, reduce ischemia, and improve quality of life. The commonly used antianginal agents include nitrates, beta-blockers, calcium channel blockers, and ranolazine. When medical therapy is not adequate to relieve angina, revascularization with percutaneous coronary intervention or coronary artery bypass grafting is indicated. We review the indications and evidence for antianginal agents and other therapies for angina.