Management of stable angina

doi:10.1136/bmj.b2789

Published 17 July 2009, doi:10.1136/bmj.b2789
Cite this as: BMJ 2009;339:b2789

Editorials

Management of stable angina

Lifestyle modification, drug treatment, and evidence based discussionabout further interventions are essential

The first 150 words of the full text of this article appear below.

The management of patients with stable coronary artery disease(especially chronic stable angina) has been extensively debatedas pathophysiological concepts, drug treatments, and interventionalstrategies have evolved. From an initial focus on alleviatingsymptoms, efforts have moved to managing discrete coronary stenoseswith invasive procedures, and more recently to improving survivaland reducing myocardial infarction.

It is now well recognised that even a single coronary stenosisindicates generalised atherosclerosis of the coronary and non-coronaryvasculature. Mortality, myocardial infarction, and strokes aremore closely correlated with the extent of generalised atherosclerosisand the composition of plaques, rather than the severity ofspecific coronary stenoses. Thus, a patient with extensive "minor"stenosis may carry a higher risk of future myocardial infarctionthan one with a greater degree of stenosis apparent at onlya single site.¹ The initial response to atherosclerosis is acompensatory dilatation of the coronary artery. Therefore, angiographyunderestimates the . . . [Full text of this article]

Salim Yusuf, professor of medicine, director¹, Madhu Natarajan, associate professor of medicine¹, Ganesan Karthikeyan, CIHR Canada-HOPE scholar¹, David Taggart, professor of cardiovascular surgery²

¹ Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada, L8L 2X2, ² John Radcliffe Hospital, Oxford OX3 9DU

yusufs@mcmaster.ca