Medical Treatment of Stable Angina

Abstract

The medical treatment for patients with stable angina rests in correcting risk factors predisposing to the progression of coronary heart disease and unstable coronary artery plaques. High importance should be given to lowering low-density lipoprotein values as far below 100 mg/dl as possible with diet and medication, usually a statin. Control of blood pressure, blood sugar, and heart rate are very important. Medications that reduce myocardial oxygen demand (beta blockers) and those that increase myocardial blood fl ow (nitrates and selected calcium antagonists in appropriate patients) are sometimes also important. Aspirin therapy to reduce risk of intracoronary thrombus formation and possibly attenuate infl ammation is also important in all patients who are able to take it. The patient on ideal medical therapy with angina or objective evidence of myocardial ischemia at rest or low levels of effort should undergo coronary arteriography with a plan to proceed to percutaneous coronary intervention or coronary artery surgery when the coronary anatomy allows. Patients with heart failure and stable angina need to be evaluated similarly with imaging procedures that characterize their left ventricular function, cardiac valves, and pulmonary artery pressure. Patients with stable angina usually have angina with effort, exercise, or emotion; after eating relatively large meals; or during other stressful circumstances that increase myocardial oxygen demand by increasing heart rate, contractile state, or ventricular wall tension. Cold exposure also causes angina by increasing myocardial wall tension, increasing blood pressure, and causing coronary artery vasoconstriction.