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EDITORIALS: Thomas F Lüscher Treatment of stable angina BMJ 2000; 321: 62-63 [Full text]

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Medicine can reduce coronary stenosis

H T Ong   (14 July 2000)

Medicine can reduce coronary stenosis 14 July 2000
H T Ong, Consultant Cardiologist H T Ong Heart Clinic, Penang, Malaysia Send response to journal: Re: Medicine can reduce coronary stenosis	Luscher in his editorial states that "it is a disadvantage of medical treatment that it does not reduce coronary stenosis" (1). In fact, lowering serum lipid levels have been proven angiographically to reduce progression and induce regression of coronary atheroma (2). Furthermore, the medical therapy of angina evolves constantly, with ACE inhibitors now being shown to exert a favourable prognostic effect in reducing ischemic cardiovascular events even in patients of normal left ventricular function (3). Given that coronary atherosclerosis is part of a systemic problem, affecting the circulation of the heart, brain and peripheral arteries, it is only logical that the therapy for angina is basically medical. Intervention, whether by angioplasty or surgery, should only be used when the obstructive lesion is either causing discomfort not relieved by medicine, or so severe as to threaten prognosis. And even then, the relief of angioplasty or surgery has to be accompanied by intense medical therapy, least the stenosis recurs at the site of intervention or elsewhere in the circulation. References: 1.Luscher TF. Treatment of stable angina. BMJ 2000; 321:62-3. 2.Superko HR, Krauss RM. Coronary artery disease regression. Convincing evidence for the benefit of aggressive lipoprotein management. Circulation 1994; 90;1056-69. 3.The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342:145-53.