Stable Angina Pectoris

Patients with stable Canadian Heart Classification I or II angina pectoris may be managed successfully with a conservative medical program. Such a program should always include aspirin, beta-blocking agents, and lipid-lowering therapies unless contraindications to them exist. Exercise and dietary restrictions will achieve target lipid values in some patients; the remainder should be treated with a lipid-lowering drug if they are at high risk of cardiac events. Emerging data support a role for angiotensin-converting enzyme inhibitors in many, if not all, patients with coronary artery disease. The role of calcium antagonists in this population remains uncertain, with some favorable and some unfavorable effects seen with these agents. High-risk patients and those with a desire to achieve greater exercise tolerance once medical therapies have been optimized are suitable candidates for angiographic study and revascularization. Although randomized studies addressing this population are limited, available data support the benefits of either coronary artery bypass grafting or percutaneous catheter intervention.