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Ischemic heart disease

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Opinion Statement

The goals of treatment of ischemic heart disease are to relieve symptoms, prevent unstable angina or myocardial infarction, and prolong life. Over the past four decades, significant advances in therapy have occurred, initially involving revascularization procedures. Although coronary bypass surgery and percutaneous catheter-based interventions continue to play an important role in therapy, appropriate medical therapy has been shown to have a major impact on the course of the disease and can decrease the need for revascularization. Lifestyle changes (eg, cessation of smoking) and pharmacologic therapy (eg, the use of aspirin, beta-blockers, and lipid-lowering agents) have been shown to decrease the occurrence of acute ischemic events and to prolong life in patients with coronary disease. Although it is likely that new therapies will emerge as our understanding of the basic mechanism of atherosclerosis increases, it is important to be sure that current medical therapy is provided to all appropriate patients.

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References and Recommended Reading

  1. Ravin HB, Falk E: Histopathology of plaque rupture. Cardiol Clin 1999, 17:263–270.

    Article  Google Scholar 

  2. Shah PK: Plaque disruption and thrombosis. Potential role of inflammation and infection. Cardiol Clin 1999, 17:2271–2281.

    Article  Google Scholar 

  3. Fuster V: Lewis A. Conner Memorial Lecture. Mechanisms leading to myocardial infarction: insights from studies of vascular biology. Circulation 1994, 90:2126–2146.

    PubMed  CAS  Google Scholar 

  4. Brown BG, Zhao X-Q, Sacco DE, Alberts JJ: Lipid lowering and plaque regression: new insights into prevention of plaque disruption and clinical events in coronary disease. Circulation 1993, 87:1781–1791.

    PubMed  CAS  Google Scholar 

  5. Gibbons RJ, Chatterjee K, Daley J, et al.: ACC/AHA/ ACP-ASIM 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 (Committee on Management of Patients with Chronic Stable Angina). J Am Coll Cardiol 1999, 33:2092–2190. This is a comprehensive review of the current literature with an extensive reference list.

    Article  PubMed  CAS  Google Scholar 

  6. Wexler L, Brundage B, Crouse J, et al.: Coronary artery calcification: pathophysiology, epidemiology, imaging methods and clinical implications. A statement for health professionals from the American Heart Association. Circulation 1996, 94:1175–1192.

    PubMed  CAS  Google Scholar 

  7. Alexander KP, Shaw LJ, Delong ER, et al.: Value of exercise testing in woman. J Am Coll Cardiol 1998, 32:1657–1664.

    Article  PubMed  CAS  Google Scholar 

  8. Scandinavian Simvastatin Survival Study Group: Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: Scandinavian Simvastatin Survival Study (4S). Lancet 1994, 344:1383–1389. This was the first randomized study to demonstrate that lipid lowering reduced total mortality rate in patients with coronary disease.

    Article  Google Scholar 

  9. Physician’s Desk Reference. Montvale, NJ: Medical Economics Company, Inc.: 1999.

  10. Rubins HB, Robins SJ, Collins D, et al.: Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. N Engl J Med 1999, 341:410–418. This study demonstrates that increasing the high-density lipoprotein level and lowering the triglyceride level without reducing the low-density lipoprotein level can decrease cardiac events in men with coronary disease.

    Article  PubMed  CAS  Google Scholar 

  11. Lipid Research Clinics Program: The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease. JAMA 1984, 251:351–364.

    Article  Google Scholar 

  12. Canner PL, Berge KG, Winger NK, et al.: Fifteen year mortality in Coronary Drug Project patients: long-term benefits with niacin. J Am Coll Cardiol 1986, 8:1245–1255.

    Article  PubMed  CAS  Google Scholar 

  13. Johannesson M, Jonsson B, Kjekshus J, et al.: Costeffectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease. N Engl J Med 1997, 336:332–336. This study demonstrates that lowering cholesterol level in patients with coronary disease is cost effective in both men and women.

    Article  PubMed  CAS  Google Scholar 

  14. Antiplatelet Trialists’ Collaboration: Collaborative overview of randomized trials of antiplatelet therapy. I. Prevention of death, myocardial infarction and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994, 308:81–106.

    Google Scholar 

  15. CAPRIE Steering Committee: A randomized, blinded trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE). Lancet 1996, 348:1329–1339.

    Article  Google Scholar 

  16. Pepine CJ, Cohn PF, Deedwania PC, et al.: Effects of treatment on outcome in mildly symptomatic patients with ischemia during daily life. The Atenolol Silent Ischemia Study (ASIST). Circulation 1994, 90:762–768.

    PubMed  CAS  Google Scholar 

  17. Furberg CD, Psaty BM, Meyer JV: Nifedipine: doserelated increase in mortality in patients with coronary heart disease. Circulation 1995, 92:1326–1331.

    PubMed  CAS  Google Scholar 

  18. Holmes DR Jr, Hirshfeld J Jr, Faxon D: ACC expert consensus document on coronary artery stents. J Am Coll Cardiol 1998, 32:1471–1482.

    Article  PubMed  Google Scholar 

  19. The EPISTENT Investigators: Randomized placebocontrolled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein IIb/IIIa blockade. Lancet 1998, 352:87–92.

    Article  Google Scholar 

  20. Pitt B, Waters D, Brown WV, et al.: Aggressive lipidlowering therapy compared with angioplasty in stable coronary artery disease. N Engl J Med 1999, 341:70–76. This important study demonstrated that aggressive medical therapy in coronary disease can result in outcomes at least as good as those associated with angioplasty.

    Article  PubMed  CAS  Google Scholar 

  21. Weintraub WS, Mauldin PD, Becker E, et al.: A comparison of the costs and quality of life after coronary angioplasty or coronary surgery for multivessel coronary artery disease. Results from the Emory Angioplasty versus Surgery Trial (EAST). Circulation 1995, 92:2831–2840.

    PubMed  CAS  Google Scholar 

  22. Eagle KA, Guyton RA, Davidoff R: ACC/AHA guidelines for coronary artery bypass surgery. J Am Coll Cardiol 1999, 34:1262–1347. These guidelines carefully review the current literature and include an extensive reference list.

    Article  PubMed  CAS  Google Scholar 

  23. Pocock SJ, Henderson RA, Rickards AF, et al.: Metaanalysis of randomized trials comparing coronary angioplasty with bypass surgery. Lancet 1995, 346:1184–1189.

    Article  PubMed  CAS  Google Scholar 

  24. The BARI Investigators: Influence of diabetes on 5-year mortality and morbidity in a randomized trial comparing CABG and PTCA in patients with multivessel disease. The Bypass Angioplasty Revascularization Investigation (BARI). Circulation 1997, 96:1761–1769.

    Google Scholar 

  25. Stephens NG, Parsons A, Schofield PM, et al.: Randomized controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS). Lancet 1996, 347:781–786.

    Article  PubMed  CAS  Google Scholar 

  26. Omenn GS, Bechesford SAA, Motulsky AG: Preventing coronary heart disease: B vitamins and homocysteine. Circulation 1998, 97:421–424.

    PubMed  CAS  Google Scholar 

  27. Hulley S, Grady D, Bush T, et al.: Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA 1998, 280:605–613. This large randomized trial of hormone replacement therapy did not show the beneficial cardiac effect expected on the basis of previous observational studies. This again confirms the importance of prospective randomized trials.

    Article  PubMed  CAS  Google Scholar 

  28. Schumacher B, Decker P, Von Specht BU, Stemann TH: Induction of neoangiogenesis in ischemic myocardium by human growth factors. First clinical results of a new treatment of coronary heart disease. Circulation 1998, 97:645–650. This study involves an interesting and innovative technique with great future potential.

    PubMed  CAS  Google Scholar 

  29. Lange RA, Hillis LD: Transmyocardial laser revascularization. N Engl J Med 1999, 341:1075–1076.

    Article  PubMed  CAS  Google Scholar 

  30. Arora RR, Chou TM, Jain D, et al.: The multicenter study of enhanced external counterpulsation (MUST-EECP): effect of EECP on exercise-induced myocardial ischemia and anginal episodes. J Am Coll Cardiol 1999, 33:1833–1840.

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Medicine, Buffalo General Hospital, 100 High Street, 14203, Buffalo, NY, USA

    Jeffrey S. Schwartz MD

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  1. Jeffrey S. Schwartz MD
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Schwartz, J.S. Ischemic heart disease. Curr Treat Options Cardio Med 2, 27–35 (2000). https://doi.org/10.1007/s11936-000-0026-x

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  • DOI: https://doi.org/10.1007/s11936-000-0026-x

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