skip to content
Dovepress - Open Access to Scientific and Medical Research
View our mobile site

8852

Recent advances in the management of chronic stable angina I: Approach to the patient, diagnosis, pathophysiology, risk stratification, and gender disparities

Review

(5101) Views  (1447) Full article downloads

Authors: Richard Kones

Published Date July 2010 Volume 2010:6 Pages 635 - 656
DOI: http://dx.doi.org/10.2147/VHRM.S7564

Richard Kones

The Cardiometabolic Research Institute, Houston, Texas 77054 USA

Abstract: The potential importance of both prevention and personal responsibility in ­controlling heart disease, the leading cause of death in the USA and elsewhere, has attracted renewed ­attention. Coronary artery disease is preventable, using relatively simple and inexpensive lifestyle changes. The inexorable rise in the prevalence of obesity, diabetes, dyslipidemia, and ­hypertension, often in the risk cluster known as the metabolic syndrome, drives the ­ever-increasing incidence of heart disease. Population-wide improvements in personal health habits appear to be a fundamental, evidence based public health measure, yet numerous barriers prevent implementation. A common symptom in patients with coronary artery disease, classical angina refers to the typical chest pressure or discomfort that results when myocardial oxygen demand rises and coronary blood flow is reduced by fixed, atherosclerotic, obstructive lesions. Different forms of angina and diagnosis, with a short description of the significance of pain and silent ischemia, are discussed in this review. The well accepted concept of myocardial oxygen imbalance in the genesis of angina is presented with new data about clinical pathology of stable angina and acute coronary syndromes. The roles of stress electrocardiography and stress myocardial perfusion scintigraphic imaging are reviewed, along with the information these tests provide about risk and prognosis. Finally, the current status of gender disparities in heart disease is summarized. Enhanced risk stratification and identification of patients in whom procedures will meaningfully change management is an ongoing quest. Current guidelines emphasize efficient triage of patients with suspected coronary artery disease. Many experts believe the predictive value of current decision protocols for coronary artery disease still needs improvement in order to optimize outcomes, yet avoid unnecessary coronary angiograms and radiation exposure. Coronary angiography remains the gold standard in the diagnosis of coronary artery obstructive disease. Part II of this two part series will address anti-ischemic therapies, new agents, cardiovascular risk reduction, options to treat refractory angina, and revascularization.

Keywords: angina, coronary artery disease, ischemic heart disease, myocardial oxygen ­balance, cardiovascular risk assessment, acute coronary syndrome, electrocardiographic stress testing, stress myocardial perfusion imaging, gender disparities in heart disease, silent ischemia, coronary angiography




 

Other articles by Dr Richard Kones



Readers of this article also read:

A review and empirical study of the composite scales of the Das–Naglieri cognitive assessment system
Role of aliskiren in cardio-renal protection and use in hypertensives with multiple risk factors
Recent advances in the management of chronic stable angina II. Anti-ischemic therapy, options for refractory angina, risk factor reduction, and revascularization
Mitochondrial therapy for Parkinson’s disease: Neuroprotective pharmaconutrition may be disease-modifying
Rosuvastatin, inflammation, C-reactive protein, JUPITER, and primary prevention of cardiovascular disease – a perspective
Primary prevention of coronary heart disease: integration of new data, evolving views, revised goals, and role of rosuvastatin in management. A comprehensive survey
Dabigatran for prophylaxis of thromboembolic events in patients with atrial fibrillation
  • Join ISVH

    Be part of the World's leading experts in vascular health by joining the International Society of Vascular Health (ISVH)

  • Testimonials

    "... I was impressed at the rapidity of publication from submission to final acceptance." Dr Edwin Thrower, PhD, Yale University