Management of Stable Angina Pectoris, Update 2017: A Critical Appraisal

A variety of pathophysiologic mechanisms may be responsible for precipitating episodes of stable angina pectoris (SAP). Most of the patients with SAP can be managed with medical therapy and or coronary artery revascularization procedures. Current Guidelines for symptomatic treatment of SAP are not always evidence based and are mostly expert opinion based. Selection of initial and subsequent add on antianginal medication for treating SAP are based on their pharmacologic effects rather than from comparative randomized- placebo controlled trials. None of the approved antianginal drugs, or coronary artery revascularization procedures have been shown to improve survival in patients with SAP. Drug therapy based on patient’s circulatory status (heart rate and systolic blood pressure) have been recently recommended and seem a rational approach, but these recommendations are not evidence based. Similarly, presence or absence of comorbidities (chronic obstructive pulmonary disease, high blood pressure, chronic kidney disease, diabetes, atrial fibrillation and peripheral arterial disease) may influence response to treatment, and yet no adequate placebo controlled studies are available to guide treatment. All patients with angina must refrain from smoking tobacco and lead a healthy life style. Patients with SAP who have CAD should be treated with a statin and low dose aspirin, provided there are no contraindications, to prevent serious adverse clinical outcomes.