Stable angina: current state of disease management

To describe the epidemiology, impact, pathogenesis, patient presentation, and treatment of stable angina, including the use of vasculoprotective and antianginal drug therapies and coronary revascularization procedures.

Stable angina is an age-related condition that typically affects men at an earlier age than women, adversely affects quality of life, and increases mortality. Stable angina is the result of an increase in myocardial oxygen demand in the setting of coronary arteries chronically narrowed by large, stable atherosclerotic plaques and a diminished myocardial oxygen supply. The characteristics of the chest pain or discomfort contribute to the clinical presentation. Treatment guidelines call for efforts to modify CHD risk, antianginal drug therapy, and patient education. Angiotensin-converting enzyme inhibitors and low-dose aspirin or clopidogrel may be used to reduce the risk of myocardial infarction and death. A beta-blocker or a nondihydropyridine calcium channel blocker may be used as initial antianginal drug therapy, and a long-acting nitrate or dihydropyridine calcium channel blocker may be added. The choice among antianginal drug therapies often hinges on patient characteristics, contraindications, and adverse effects. Revascularization with percutaneous coronary intervention or coronary artery bypass graft surgery is an option for ischemia refractory to maximum tolerated dosages of antianginal therapy.

Various drug therapies may be used to manage stable angina, with coronary revascularization as an option in patients who are refractory to drug therapy. However, antianginal drug therapies may prove inadequate for managing anginal episodes for a variety of reasons, and revascularization is not always effective.