Skip to main content

Advertisement

SpringerLink
Log in

Medical Management of Stable Coronary Atherosclerosis

  • Coronary Heart Disease (JA Farmer, Section Editor)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Revascularisation strategies involving coronary artery bypass grafting or percutaneous interventions are the main treatments for stable coronary artery disease, particularly for patients with ongoing symptoms despite medical therapy and/or extensive ischaemia as demonstrated by either non-invasive or invasive means. Irrespective of whether revascularisation is being undertaken, all patients with stable coronary disease require optimal medical therapy in order to reduce the risk of subsequent adverse cardiac events, particularly acute myocardial infarction. The role of medical management has been very actively investigated and reported, particularly because of the global disease burden and the associated high morbidity and mortality. In this review, the current available medical management for the treatment of coronary atherosclerosis is described together with the role and prospects of the newer classes of drugs that are coming into use, and future perspectives in this field.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352(16):1685–95.

    Article  PubMed  CAS  Google Scholar 

  2. Mautner RK, Phillips JH. Percutaneous transluminal coronary angioplasty. JAMA. 1979;242(15):1625–6.

    Article  PubMed  CAS  Google Scholar 

  3. Williams DO, Riley RS, Singh AK, Most AS. Restoration of normal coronary hemodynamics and myocardial metabolism after percutaneous transluminal coronary angioplasty. Circulation. 1980;62(3):653–6.

    Article  PubMed  CAS  Google Scholar 

  4. Coronary angioplasty versus medical therapy for angina: the second Randomised Intervention Treatment of Angina (RITA-2) trial. RITA-2trial participants. Lancet. 1997;350(9076):461.

  5. Varnauskas E. Twelve-year follow-up of survival in the randomized European Coronary Surgery Study. N Engl J Med. 1988;319(6):332–7.

    Article  PubMed  CAS  Google Scholar 

  6. The Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group. Eleven-year survival in the Veterans Administration randomized trial of coronary bypass surgery for stable angina. N Engl J Med. 1984;311(21):1333–9.

    Article  Google Scholar 

  7. Schömig A, Mehilli J, de Waha A, Seyfarth M, Pache J, Kastrati A. A meta-analysis of 17 randomized trials of a percutaneous coronary intervention-based strategy in patients with stable coronary artery disease. J Am Coll Cardiol. 2008;52(11):894–904.

    Article  PubMed  Google Scholar 

  8. Arbab-Zadeh A. Medical therapy versus percutaneous coronary intervention for patients with stable coronary artery disease. J Am Coll Cardiol. 2009;53(6):528.

    Article  PubMed  Google Scholar 

  9. Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, COURAGE Trial Research Group, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503–16.

    Article  PubMed  CAS  Google Scholar 

  10. Cai Q, Barbagelata A, Ahmad M. Management of stable coronary artery disease: from COURAGE, FAME II, to ISCHEMIA. J Clin Exp Cardiol. 2012;3:5.

    Google Scholar 

  11. Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2004;110:e340–437.

    Article  PubMed  Google Scholar 

  12. Silber S, Albertsson P, Aviles FF, et al. Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J. 2005;26:804–47.

    Article  PubMed  Google Scholar 

  13. Lange RA, Hillis LD. Coronary revascularization in context. N Engl J Med. 2009;360(10):1024–6.

    Article  PubMed  CAS  Google Scholar 

  14. • Min JK, Leipsic J, Pencina MJ, Berman DS, Koo BK, van Mieghem C, et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA. 2012;308(12):1237–45. The use of non-invasive fractional flow reserve plus computed tomography angiography among stable patients with suspected or known CAD was associated with improved diagnostic accuracy and discrimination versus computed tomography alone for the diagnosis of haemodynamically significant CAD.

    PubMed  CAS  Google Scholar 

  15. Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117(10):1283–91.

    Article  PubMed  Google Scholar 

  16. Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F, et al. Guidelines on the management of stable angina pectoris: executive summary: the Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J. 2006;27(11):1341–81.

    Article  PubMed  Google Scholar 

  17. Smith Jr SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation. 2006;113(19):2363–72.

    Article  PubMed  Google Scholar 

  18. Fraker Jr TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, et al. Chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina. Circulation. 2007;116(23):2762–72.

    Article  PubMed  Google Scholar 

  19. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99(6):779–85.

    Article  PubMed  Google Scholar 

  20. Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008;337:a1344. doi:10.1136/bmj.a1344.

    Article  PubMed  Google Scholar 

  21. Palozza P, Parrone N, Catalano A, Simone R. Tomato lycopene and inflammatory cascade: basic interactions and clinical implications. Curr Med Chem. 2010;17(23):2547–63.

    Article  PubMed  CAS  Google Scholar 

  22. Terao J. Dietary flavonoids as antioxidants. Forum Nutr. 2009;61:87–94.

    Article  PubMed  CAS  Google Scholar 

  23. Song L, Xu M, Lopes-Virella MF, Huang Y. Quercetin inhibits matrix metalloproteinase-1 expression in human vascular endothelial cells through extracellular signal-regulated kinase. Arch Biochem Biophys. 2001;391(1):72–8.

    Article  PubMed  CAS  Google Scholar 

  24. Xia M, Ling WH, Ma J, Kitts DD, Zawistowsk J. Supplementation of diets with black rice pigment fraction attenuates atherosclerotic plaque formation in apolipoprotein E-deficient mice. J Nutr. 2003;133:744–51.

    PubMed  CAS  Google Scholar 

  25. Naruszewicz M, Zapolska-Downar D, Kośmider A, Nowicka G, Kozłowska-Wojciechowska M, Vikström AS, et al. Chronic intake of potato chips in humans increases the production of reactive oxygen radicals by leukocytes and increases plasma C-reactive protein: a pilot study. Am J Clin Nutr. 2009;89(3):773–7.

    Article  PubMed  CAS  Google Scholar 

  26. Parish S, Collins R, Peto R, Youngman L, Barton J, Jayne K, The International Studies of Infarct Survival (ISIS) Collaborators, et al. Cigarette smoking, tar yields, and non-fatal myocardial infarction: 14,000 UK cases and 32,000 controls in the United Kingdom. BMJ. 1995;311:471–77.

    Article  PubMed  CAS  Google Scholar 

  27. Teo KK, Ounpuu S, Hawken S, Pandey MR, Valentin V, Hunt D, et al. Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case–control study. Lancet. 2006;368(9536):647–58.

    Article  PubMed  Google Scholar 

  28. Erbel R, Budoff M. Improvement of cardiovascular risk prediction using coronary imaging: subclinical atherosclerosis: the memory of lifetime risk factor exposure. Eur Heart J. 2012;33(10):1201–13.

    Article  PubMed  Google Scholar 

  29. Lang NN, Gudmundsdóttir IJ, Boon NA, Ludlam CA, Fox KA, Newby DE. Marked impairment of protease-activated receptor type 1-mediated vasodilation and fibrinolysis in cigarette smokers: smoking, thrombin, and vascular responses in vivo. J Am Coll Cardiol. 2008;52(1):33–9.

    Article  PubMed  CAS  Google Scholar 

  30. Miller 3rd ER, Appel LJ, Jiang L, Risby TH. Association between cigarette smoking and lipid peroxidation in a controlled feeding study. Circulation. 1997;96(4):1097–101.

    Article  PubMed  Google Scholar 

  31. Newby D, Wright RA, Labinjoh C, Ludlam CA, Fox KAA, Boon NA, et al. Endothelial dysfunction, impaired endogenous fibrinolysis, and cigarette smoking: a mechanism for arterial thrombosis and myocardial infarction. Circulation. 1999;99:1411–5.

    Article  PubMed  CAS  Google Scholar 

  32. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA. 2003;290(1):86–97.

    Article  PubMed  Google Scholar 

  33. Blair SN, Kohl HW JR, Paffenbarger Jr RS, Clark DG, Cooper KH, Gibbons LW. Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA. 1989;262(17):2395–401.

    Article  PubMed  CAS  Google Scholar 

  34. Jenkins NT, Martin JS, Laughlin MH, Padilla J. Exercise-induced signals for vascular endothelial adaptations: implications for cardiovascular disease. Curr Cardiovasc Risk Rep. 2012;6(4):331–46.

    Article  PubMed  Google Scholar 

  35. Mora S, Cook N, Buring JE, Ridker PM, Lee I. Physical activity and reduced risk of cardiovascular events. Potential mediating mechanisms. Circulation. 2007;116:2110–8.

    Article  PubMed  CAS  Google Scholar 

  36. Escalante Y, Saavedra JM, García-Hermoso A, Domínguez AM. Improvement of the lipid profile with exercise in obese children: a systematic review. Prev Med. 2012;54(5):293–301.

    Article  PubMed  CAS  Google Scholar 

  37. Kortelainen ML. Adiposity, cardiac size and precursors of coronary atherosclerosis in 5 to 15-year-old children: a retrospective study of 210 violent deaths. Int J Obes Relat Metab Disord. 1997;21(8):691–7.

    Article  PubMed  CAS  Google Scholar 

  38. Augusto Libardi C, Bonganha V, Soares Conceição M, Vergínia De Souza G, Fernandes Bernardes C, Secolin R, Aparecida Madruga V, Traina Chacon-Mikahil MP. The periodized resistance training promotes similar changes in lipid profile in middle-aged men and women. J Sports Med Phys Fitness. 2012;52(3):286–92.

    PubMed  CAS  Google Scholar 

  39. Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J. 2011;162(4):571–84.

    Article  PubMed  Google Scholar 

  40. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;26(53):1925–32.

    Article  Google Scholar 

  41. Romero-Corral A, Montori VM, Somers VK, Korinek J, Thomas RJ, Allison TG, Mookadam F, Lopez-Jimenez F. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006;368(9536):666–78.

    Article  PubMed  Google Scholar 

  42. Habbu A, Lakkis NM, Dokainish H. The obesity paradox: fact or fiction? Am J Cardiol. 2006;98(7):944–8.

    Article  PubMed  Google Scholar 

  43. National Cholesterol Education Program. Executive summary of the third report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486–97.

    Article  Google Scholar 

  44. Libby P, Aikawa M. Mechanisms of plaque stabilization with statins. Am J Cardiol. 2003;91(4A):4B–8B.

    Article  PubMed  CAS  Google Scholar 

  45. Libby P, Crea F. Clinical implications of inflammation for cardiovascular primary prevention. Eur Heart J. 2010;31(7):777–83.

    Article  PubMed  CAS  Google Scholar 

  46. Lee K, Ahn TH, Kang WC, Han SH, Choi IS, Shin EK. The effects of statin and niacin on plaque stability, plaque regression, inflammation and oxidative stress in patients with mild to moderate coronary artery stenosis. Korean Circ J. 2011;41(11):641–8.

    Article  PubMed  CAS  Google Scholar 

  47. Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto Jr AM, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359(21):2195–207.

    Article  PubMed  CAS  Google Scholar 

  48. The Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383–9.

    Google Scholar 

  49. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:7–22.

    Article  Google Scholar 

  50. Serruys PW, de Feyter P, Macaya C, Kokott N, Puel J, Vrolix M, et al. Fluvastatin for prevention of cardiac events following successful first percutaneous coronary intervention: a randomized controlled trial. JAMA. 2002;287:3215–22.

    Article  PubMed  CAS  Google Scholar 

  51. Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM, Cobbe SM, et al. PROspective Study of Pravastatin in the Elderly at Risk. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002;360(9346):1623–30.

    Article  PubMed  CAS  Google Scholar 

  52. Jones PH, Davidson MH, Stein EA, et al. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR trial). Am J Cardiol. 2003;92:152–60.

    Article  PubMed  CAS  Google Scholar 

  53. •• Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376(9753):1670–81. Further reductions in LDL cholesterol levels safely produce definite further reductions in the incidence of myocardial infarction.

    Article  PubMed  CAS  Google Scholar 

  54. •• Preiss D, Seshasai SR, Welsh P, Murphy SA, Ho JE, Waters DD, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA. 2011;305(24):2556–64. In a pooled analysis of data from five statin trials, intensive-dose statin therapy was associated with an increased risk of new-onset diabetes compared with moderate-dose statin therapy.

    Article  PubMed  CAS  Google Scholar 

  55. • Petretta M, Costanzo P, Perrone-Filardi P, Chiariello M. Impact of gender in primary prevention of coronary heart disease with statin therapy: a meta-analysis. Int J Cardiol. 2010;38(1):25–31. Evidence for reductions in the incidence of cardiovascular events in primary prevention was stronger in men than in women.

    Article  Google Scholar 

  56. Gotto Jr AM, Moon JE. Recent clinical studies of the effects of lipid-modifying therapies. Am J Cardiol. 2012;110(1 Suppl):15A–26A.

    Article  PubMed  CAS  Google Scholar 

  57. Kastelein JJ, Akdim F, Stroes ES, Zwinderman AH, Bots ML, Stalenhoef AF, et al. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med. 2008;358(14):1431–43.

    Article  PubMed  CAS  Google Scholar 

  58. Villines TC, Stanek EJ, Devine PJ, Turco M, Miller M, Weissman NJ, et al. The ARBITER6-HALTS Trial (Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol 6-HDL and LDL Treatment Strategies in Atherosclerosis): final results and the impact of medication adherence, dose, and treatment duration. J Am Coll Cardiol. 2010;55(24):2721–6.

    Article  PubMed  Google Scholar 

  59. • Costanzo P, Perrone-Filardi P, Vassallo E, Paolillo S, Cesarano P, Brevetti G, et al. Does carotid intima-media thickness regression predict reduction of cardiovascular events? A meta-analysis of 41 randomized trials. J Am Coll Cardiol. 2010;56(24):2006–20. CIMT changes induced by primary and secondary prevention therapy were shown to not predict cardiovascular morbidity and mortality.

    Article  PubMed  Google Scholar 

  60. Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C, et al. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet. 2011;377(9784):2181–92.

    Article  PubMed  CAS  Google Scholar 

  61. Kamanna VS, Kashyap ML. Mechanism of action of niacin. Am J Cardiol. 2008;101(8A):20B–6B.

    Article  PubMed  CAS  Google Scholar 

  62. Brown BG, Zhao XQ, Chait A, Fisher LD, Cheung MC, Morse JS, et al. Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease. N Engl J Med. 2001;345(22):1583–92.

    Article  PubMed  CAS  Google Scholar 

  63. Lee JM, Robson MD, Yu LM, Shirodaria CC, Cunnington C, Kylintireas I, et al. Effects of high-dose modified-release nicotinic acid on atherosclerosis and vascular function: a randomized, placebo-controlled, magnetic resonance imaging study. J Am Coll Cardiol. 2009;54(19):1787–94.

    Article  PubMed  CAS  Google Scholar 

  64. • Boden WE, Probstfield JL, Anderson T, Chaitman BR, Desvignes-Nickens P, Koprowicz K, et al. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med. 2011;365(24):2255–67. Niacin, an old revisited lipid-lowering drug, despite being shown to be effective in increasing HDL levels when added to statin therapy showed no increased clinical benefit at 36 months of follow-up.

    Article  PubMed  CAS  Google Scholar 

  65. He K, Song Y, Daviglus ML, Liu K, Van Horn L, Dyer AR, Greenland P. Accumulated evidence on fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies. Circulation. 2004;109:2705–11.

    Article  PubMed  Google Scholar 

  66. Hartweg J, Perera R, Montori V, Dinneen S, Neil HA, Farmer A. Omega-3 polyunsaturated fatty acids (PUFA) for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2008;(1):CD003205.

  67. • Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA. 2012;308(10):1024–33. Omega-3 PUFA supplementation was not associated with a lower risk of all-cause mortality, cardiac death, sudden death, myocardial infarction or stroke on the basis of relative and absolute measures of association.

    Article  PubMed  CAS  Google Scholar 

  68. Staels B, Dallongeville J, Auwerx J, Schoonjans K, Leitersdorf E, Fruchart JC. Mechanism of action of fibrates on lipid and lipoprotein metabolism. Circulation. 1998;98(19):2088–93.

    Article  PubMed  CAS  Google Scholar 

  69. The FIELD Study Investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005;366:1849–61.

    Article  CAS  Google Scholar 

  70. • ACCORD Study Group, Ginsberg HN, Elam MB, Lovato LC, 3rd Crouse JR, Leiter LA, Linz P, et al. Effects of combination lipidt therapy in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1563–74. Fenofibrate in association with statins did not reduce the incidence of cardiovascular events more than statins alone in diabetic patients.

    Article  PubMed  Google Scholar 

  71. ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction. J Am Coll Cardiol. 1988;12(6 Suppl A):3A–13A.

    Google Scholar 

  72. De Berardis G, Lucisano G, D’Ettorre A, Pellegrini F, Lepore V, Tognoni G, et al. Association of aspirin use with major bleeding in patients with and without diabetes. JAMA. 2012;307(21):2286–94.

    Article  PubMed  Google Scholar 

  73. Juul-Möller S, Edvardsson N, Jahnmatz B, Rosén A, Sørensen S, Omblus R, The Swedish Angina Pectoris Aspirin Trial (SAPAT) Group. Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina pectoris. Lancet. 1992;340(8833):1421–5.

    Article  PubMed  Google Scholar 

  74. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348(9038):1329–39.

    Article  Google Scholar 

  75. Gurbel PA, Bliden KP, Butler K, Tantry US, Gesheff T, Wei C, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation. 2009;120(25):2577–85.

    Article  PubMed  CAS  Google Scholar 

  76. Braun OO, Johnell M, Varenhorst C, James S, Brandt JT, Jakubowski JA, et al. Greater reduction of platelet activation markers and platelet-monocyte aggregates by prasugrel compared to clopidogrel in stable coronary artery disease. Thromb Haemost. 2008;100(4):626–33.

    PubMed  CAS  Google Scholar 

  77. Cleland JG, Mumtaz S, Cecchini L. Role of antithrombotic agents in heart failure. Curr Cardiol Rep. 2012;14(3):314–25.

    Article  PubMed  Google Scholar 

  78. Sipahi I, Tuzcu EM, Wolski KE, Nicholls SJ, Schoenhagen P, Hu B, et al. Beta-blockers and progression of coronary atherosclerosis: pooled analysis of 4 intravascular ultrasonography trials. Ann Intern Med. 2007;147(1):10–8.

    PubMed  Google Scholar 

  79. Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med. 1998;339(8):489–97.

    Article  PubMed  CAS  Google Scholar 

  80. Bangalore S, Steg G, Deedwania P, Crowley K, Eagle KA, Goto S, et al. β-Blocker use and clinicaloutcomes in stable outpatients with and without coronary artery disease. JAMA. 2012;308(13):1340–9.

    Article  PubMed  CAS  Google Scholar 

  81. Rehnqvist N, Hjemdahl P, Billing E, Björkander I, Eriksson SV, Forslund L, The Angina Prognosis Study in Stockholm (APSIS), et al. Effects of metoprolol vs verapamil in patients with stable angina pectoris. Eur Heart J. 1996;17(1):76–81.

    Article  PubMed  CAS  Google Scholar 

  82. Dargie HJ, Ford I, Fox KM, The TIBET Study Group. Total Ischaemic Burden European Trial (TIBET). Effects of ischaemia and treatment with atenolol, nifedipine SR and their combination on outcome in patients with chronic stable angina. Eur Heart J. 1996;17(1):104–12.

    Article  PubMed  CAS  Google Scholar 

  83. Heidenreich PA, McDonald KM, Hastie T, Fadel B, Hagan V, Lee BK, et al. Meta-analysis of trialscomparingbeta-blockers, calciumantagonists, and nitrates for stable angina. JAMA. 1999;281(20):1927–36.

    Article  PubMed  CAS  Google Scholar 

  84. Borer JS, Fox K, Jaillon P, Lerebours G. Antianginal and antiischemic effects of ivabradine, an I(f) inhibitor, in stable angina: a randomized, double-blind, multicentered, placebo-controlled trial. Circulation. 2003;107:817–23.

    Article  PubMed  Google Scholar 

  85. Tardif JC, Ford I, Tendera M, Bourassa MG, Fox K. Efficacy of ivabradine, a new selective If inhibitor, compared with atenolol in patients with chronic stable angina. Eur Heart J. 2005;26:2529–36.

    Article  PubMed  CAS  Google Scholar 

  86. Werdan K, Ebelt H, Nuding S, Höpfner F, Hack G, Müller-Werdan U. Ivabradine in combination with beta-blocker improves symptoms and quality of life in patients with stable angina pectoris: results from the ADDITIONS study. Clin Res Cardiol. 2012;101(5):365–73.

    Article  PubMed  CAS  Google Scholar 

  87. Fox K, Ford I, Steg G, Tendera M, Robertson M, Ferrari R. Relationship between ivabradine treatment and cardiovascular outcomes in patients with stable coronary artery disease and left ventricular systolic dysfunction with limiting angina: a subgroup analysis of the randomized controlled BEAUTIFUL trial. Eur Heart J. 2009;30(19):2337–45.

    Article  PubMed  CAS  Google Scholar 

  88. Ferrari R. A step further with ivabradine: SIGNIfY (Study assessInG the morbidity–mortality beNefits of the If inhibitor ivabradine in patients with coronarY artery disease). Eur Heart J Suppl 11 Suppl D 2009:D19.

  89. Parker JD, Parker JO. Nitratetherapy for stable angina pectoris. N Engl J Med. 1998;338(8):520–31.

    Article  PubMed  CAS  Google Scholar 

  90. Thadani U. Nitrate tolerance, rebound, and their clinical relevance in stable angina pectoris, unstable angina, and heart failure. Cardiovasc Drugs Ther. 1997;10(6):735–42.

    Article  PubMed  CAS  Google Scholar 

  91. ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group. A randomized factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. Lancet. 1995;345(8951):669–85.

    Article  Google Scholar 

  92. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico. Six-month effects of early treatment with lisinopril and transdermalglyceryl trinitrate singly and together withdrawn six weeks after acute myocardial infarction: the GISSI-3 trial. J Am Coll Cardiol. 1996;27(2):337–44.

    Google Scholar 

  93. Taira N. Nicorandil as a hybrid between nitrates and potassium channel activators. Am J Cardiol. 1989;63:18J–24J.

    Article  PubMed  CAS  Google Scholar 

  94. Ciampricotti R, Schotborgh CE, de Kam PJ, van Herwaarden RH. A comparison of nicorandil with isosorbide mononitrate in elderly patients with stable coronary heart disease: the SNAPE Study. Am Heart J. 2000;139(5):939–43.

    Article  Google Scholar 

  95. Effect of nicorandil on coronary events in patients with stable angina: the Impact Of Nicorandil in Angina (IONA) randomised trial. Lancet2002;359:1269–75.

  96. Horinaka S, Yabe A, Yagi H, Ishimitsu T, Yamazaki T, Suzuki S, et al. Effects of nicorandil on cardiovascular events in patients with coronary artery disease in the Japanese Coronary Artery Disease (JCAD) study. Circ J. 2010;74(3):503–9.

    Article  PubMed  Google Scholar 

  97. Chazov EI, Lepakchin VK, Zharova EA, Fitilev SB, Levin AM, Rumiantzeva EG, et al. Trimetazidine in Angina Combination Therapy–the TACT study: trimetazidine versus conventional treatment in patients with stable angina pectoris in a randomized, placebo-controlled, multicentre study. Am J Ther. 2005;12:35–42.

    Article  PubMed  CAS  Google Scholar 

  98. Szwed H, Sadowski Z, Elikowski W, et al. Combination treatment in stable effort angina using trimetazidine and metoprolol. Results of a randomized, double-blind, multicenter study (TRIMPOL II). Eur Heart J. 2001;22:2267–24.

    Article  PubMed  CAS  Google Scholar 

  99. Hale SL, Shryock JC, Belardinelli L, Sweeney M, Kloner RA. Late sodium current inhibition as a new cardioprotective approach. J Mol Cell Cardiol. 2008;44(6):954–67.

    Article  PubMed  CAS  Google Scholar 

  100. Stone PH. Ranolazine: new paradigm for management of myocardial ischemia, myocardial dysfunction, and arrhythmias. Cardiol Clin. 2008;26(4):603–14.

    Article  PubMed  Google Scholar 

  101. Pepine CJ, Wolff AA, Ranolazine Study Group. A controlled trial with a novel anti-ischemic agent, ranolazine, in chronic stable angina pectoris that is responsive to conventional antianginal agents. Am J Cardiol. 1999;84(1):46–50.

    Article  PubMed  CAS  Google Scholar 

  102. Chaitman BR, Pepine CJ, Parker JO, Sokpal J, Chumakova G, Kuch J, et al. Effects of ranolazine with atenolol, amlodipine, or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina: a randomized controlled trial. JAMA. 2004;291(3):309–16.

    Article  PubMed  CAS  Google Scholar 

  103. Rosendorff C. Hypertension and coronary artery disease: a summary of the American Heart Association scientific statement. J Clin Hypertens (Greenwich). 2007;9(10):790–5.

    Article  Google Scholar 

  104. Dol F, Martin G, Staels B, Mares AM, Cazaubon C, Nisato D, et al. Angiotensin AT1 receptor antagonist irbesartan decreases lesion size, chemokine expression, and macrophage accumulation in apolipoprotein E-deficient mice. J Cardiovasc Pharmacol. 2001;38(3):395–405.

    Article  PubMed  CAS  Google Scholar 

  105. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G, 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;20;342(3):145–53.

    Google Scholar 

  106. Yusuf S, Teo KK, Pogue J, Dyal L, Copland I, Schumacher H, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358(15):1547–59.

    Article  PubMed  CAS  Google Scholar 

  107. Braunwald E, Domanski MJ, Fowler SE, Geller NL, Gersh BJ, Hsia J, et al. Angiotensin-converting-enzyme inhibition in stable coronary artery disease. N Engl J Med. 2004;351(20):2058–68.

    Article  PubMed  CAS  Google Scholar 

  108. Costanzo P, Cleland J, Vassallo E, Perrone-Filardi P. Effects of angiotensin converting enzyme inhibitors and angiotensin receptors blockers on cardiovascular events in patients with or at high risk of cardiovascular disease but without heart failure. A combined analysis of randomized clinical trials. J Am Coll Cardiol. 2012;59(13):E1757.

    Article  Google Scholar 

  109. Costanzo P, Perrone-Filardi P, Petretta M, Marciano C, Vassallo E, Gargiulo P, et al. Calcium channel blockers and cardiovascular outcomes: a meta-analysis of 175,634 patients. J Hypertens. 2009;27(6):1136–51.

    Article  PubMed  CAS  Google Scholar 

  110. • Borden WB, Redberg RF, Mushlin AI, Dai D, Kaltenbach LA, et al. Patterns and intensity of medical therapy in patients undergoing percutaneous coronary intervention. JAMA. 2011;305:1882–9. Among patients with stable CAD undergoing PCI, less than half were receiving optimal medical therapy.

    Article  PubMed  CAS  Google Scholar 

  111. White H, Held C, Stewart R, Watson D, Harrington R, Budaj A, et al. Study design and rationale for the clinical outcomes of the STABILITY Trial (STabilization of Atherosclerotic plaque By Initiation of darapLadIb TherapY) comparing darapladib versus placebo in patients with coronary heart disease. Am Heart J. 2010;160(4):655–61.

    Article  PubMed  CAS  Google Scholar 

  112. Cramer JA, Benedict A, Muszbek N, Keskinaslan A, Khan ZM. The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. Int J Clin Pract. 2008;62(1):76–87.

    Article  PubMed  CAS  Google Scholar 

  113. O’Donoghue ML, Braunwald E, White HD, Serruys P, Steg PG, Hochman J, et al. Study design and rationale for the Stabilization of pLaques usIng Darapladib-Thrombolysis in Myocardial Infarction (SOLID-TIMI 52) trial in patients after an acute coronary syndrome. Am Heart J. 2011;162(4):613–619.e1.

    Article  PubMed  CAS  Google Scholar 

  114. Ridker PM. Testing the inflammatory hypothesis of atherothrombosis: scientific rationale for the cardiovascular inflammation reduction trial (CIRT). J Thromb Haemost. 2009;7 Suppl 1:332–9.

    Article  PubMed  CAS  Google Scholar 

  115. Ridker PM, Thuren T, Zalewski A, Libby P. Interleukin-1β inhibition and the prevention of recurrent cardiovascular events: rationale and design of the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS). Am Heart J. 2011;162(4):597–605.

    Article  PubMed  CAS  Google Scholar 

  116. Targeting Inflammation Using Salsalate in Cardiovascular Disease (TINSAL-CVD). ClinicalTrials.gov identifier NCT00624923.

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Academic Cardiology Unit, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, HU16 5JQ, UK

    P. Pellicori, P. Costanzo, A. C. Joseph, A. Hoye & J. G. F. Cleland

  2. Unit of Endocrinology and Metabolism, Hull York Medical School, Hull, UK

    S. L. Atkin

Authors
  1. P. Pellicori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Costanzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. C. Joseph
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Hoye
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. L. Atkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. G. F. Cleland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Costanzo.

Additional information

P. Pellicori and P. Costanzo have equal contribution.

This article is part of the Topical Collection on Coronary Heart Disease

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pellicori, P., Costanzo, P., Joseph, A.C. et al. Medical Management of Stable Coronary Atherosclerosis. Curr Atheroscler Rep 15, 313 (2013). https://doi.org/10.1007/s11883-013-0313-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11883-013-0313-0

Keywords

Search

Navigation