Impact of Life Style Modifications, Antianginals, Antiplatelets and Lipid Modifying Drugs and of Coronary Revascularization on Mortality and Morbidity in Patients with Stable Angina/Stable Ischemic Heart Disease: Truth or False Notions

摘要

Stable ischemic heart disease (SIHD) is a new term in vogue; to manage patients with SIDH appropriately, one must address not only the impact of treatment on symptoms and quality of life, but also on mortality and other serious adverse outcomes such as myocardial infarction and stroke. Life style alterations, with special emphasis on cessation of smoking, regular exercise, and lipid modifying treatment with statins, reduce the incidence of serious adverse clinical outcomes. In contrast, recent trials have shown that modifying abnormal lipids with niacin and fibrates, or raising HDL cholesterol with CTEP blockers, in addition to a statin does not decrease adverse clinical cardiovascular outcomes. Daily aspirin in patients with established SIDH; and adequate control of blood pressure in patients with SIDH, who are hypertensive also reduce serious adverse clinical outcomes. Antianginal drugs reduce angina frequency and increase exercise tolerance but have little impact on mortality with only a few exceptions, such as the use of beta blockers and ACE inhibitors after an acute myocardial infarction and in patients with reduced left ventricular systolic function. Compared to optimal medical treatment, coronary revascularization, even in patients with diabetes and SIHD, does not reduce mortality or rates of myocardial infarction, but does relieve patient symptoms more effectively at least for the short term. Older medications such as allopurinol and colchicine have shown benefit in recent trials, but large scale trials are needed before recommending their routine use. Treatment based on patients' lifestyle and presence of comorbidities which impact outcomes, and influence of treatment strategy, is always an important consideration in providing the best available treatment to patients with SIHD.