Document Detail


Current medical management of chronic stable angina.
MedLine Citation:
PMID:  15378129     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Severe atherosclerotic narrowing of one or more coronary arteries is responsible for myocardial ischemia and angina pectoris in most patients with stable angina. The coronary arteries of patients with stable angina also contain many more non-obstructive plaques, which are prone to rupture resulting in acute coronary syndrome (unstable angina, myocardial infarction, sudden ischemic death). Therefore, the medical management must use strategies which not only relieve symptoms and prolong angina free walking but also reduce the incidence of adverse clinical outcomes. Whether any of the approved antianginal drugs, nitrates, beta-blockers, and calcium channel blockers reduce the incidence of adverse clinical outcomes in patients with stable angina has not been studied to date. Published data shows that percutaneous coronary revascularization procedures and coronary bypass surgery are effective in relieving angina but these procedures do not reduce mortality or the incidence of myocardial infarction compared to anti-anginal drug therapy. From the available data, an initial trial of medical treatment with anti-anginal drugs and strategies to reduce adverse clinical outcomes (smoking cessation, daily aspirin, treatment of dyslipidemias and hypertension) is indicated in most patients with stable angina pectoris. The initial choice of drug will depend on the presence or absence of comorbid conditions. Patients who do not respond to medical therapy or do not wish to take anti-anginal drugs and whose life style is limited because of anginal symptoms should be offered percutaneous revascularization procedures with or without stent placement or coronary bypass surgery. New drug-coated stents hold promise but long-term data and large-scale trials assessing the continued long-term improvement in symptoms and reduction of adverse outcomes is needed before offering such devices to all patients with stable angina. Newer medical therapies such as metabolic modulators and sinus rate lowering drugs also hold promise but need further evaluation. Patients who have refractory angina despite optimal medical therapy and are not candidates for revascularization procedures may be candidates for some new techniques of enhanced external Counterpulsation, Spinal Cord Stimulation, sympathectomy or direct transmyocardial revascularization. The usefulness of these techniques, however, needs to be confirmed in large randomized trials.
Authors:
Udho Thadani
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Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  Journal of cardiovascular pharmacology and therapeutics     Volume:  9 Suppl 1     ISSN:  1074-2484     ISO Abbreviation:  J. Cardiovasc. Pharmacol. Ther.     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-09-20     Completed Date:  2005-06-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9602617     Medline TA:  J Cardiovasc Pharmacol Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S11-29; quiz S98-9     Citation Subset:  IM    
Affiliation:
Cardiovascular Section, University of Oklahoma Health Sciences Center, Medical Center and VA Medical Center, Oklahoma City, Oklahoma 73104, USA.
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MeSH Terms
Descriptor/Qualifier:
Angina Pectoris / epidemiology,  physiopathology,  therapy*
Animals
Chronic Disease
Drug Therapy / classification*,  trends*
Humans
Life Style
Methods
Randomized Controlled Trials as Topic
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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