Pharmacologic and lifestyle interventions remain the mainstay for angina prevention in stable coronary artery disease, with revascularization reserved for specific or refractory cases.
Supports medical-first approach in stable angina; leaves open optimal revascularization thresholds in contemporary cohorts.
PURPOSE OF REVIEW: Angina pectoris affects at least 6.6 million people in the US and approximately 400,000 new cases of stable angina occur each year. Angina may be one of the first signs of ischemic heart disease, although it is likely not causally related to the likelihood of plaque rupture leading to an acute coronary syndrome. Modalities for treatment of angina should be used maximally to improve quality of life and decrease cardiovascular morbidity and mortality. The current recommended pharmacologic and invasive approaches, as well as novel therapies, are reviewed. RECENT FINDINGS: Antiischemic agents, including beta-blockers, nitrates and calcium channel blockers, remain the mainstay in the prevention of angina. Revascularization via percutaneous interventions or coronary bypass surgery are appropriate in specific cases or when medical treatment fails. Noninvasive treatment options for refractory angina, metabolic agents, and vasodilator therapies are adding to the armamentarium to prevent and treat angina. SUMMARY: A multifaceted approach is optimal to address the prevention of angina. Once angina is recognized, there are many modalities that lessen the incidence of daily life-induced and exercise-induced angina and ischemia. Angina management is best addressed by pharmacologic and lifestyle interventions.
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Bhatt et al. (2006) studied this question.
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