Sections

Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Class Summary

Prevent thrombus formation by inhibiting platelet aggregation. Aspirin is proven beneficial in primary and secondary prevention of coronary artery disease. In patients with aspirin intolerance, use clopidogrel. Clopidogrel is also used in combination with aspirin after coronary stent placement. Recently, clopidogrel use in addition to aspirin has been shown to be significantly superior to aspirin alone in patients with acute coronary syndrome without ST-segment elevation MI.

Aspirin (Anacin, Ascriptin, Bayer Aspirin, Bayer Buffered Aspirin)

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Prevents platelet aggregation by irreversible cyclooxygenase inhibition with subsequent suppression of thromboxane A2. Antiplatelet effect can last as long as 7 d.

Clopidogrel (Plavix)

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Selectively inhibits ADP binding to platelet receptor and subsequent ADP-mediated activation of GPIIb/IIIa complex, thereby inhibiting platelet aggregation. Consider in patients with contraindication to aspirin.

Class Summary

Work by competing with endogenous catecholamines for beta-adrenergic receptors. Reduce myocardial oxygen consumption via several effects, including decrease in resting and exercise heart rates and reductions in myocardial contractility and afterload. Classified as nonselective, beta-1 selective, and having intrinsic sympathomimetic effects.

Metoprolol (Lopressor, Toprol XL)

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Selective beta1-adrenergic receptor blocker that decreases automaticity of contractions. Is lipophilic and penetrates CNS.

Atenolol (Tenormin)

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Selectively blocks beta-1 receptors with little or no effect on beta-2 receptors. Is hydrophilic and does not penetrate CNS.

Propranolol (Inderal)

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Nonselective beta-blocker that is lipophilic (penetrates CNS). Although generally short-acting agent, long-acting preparations also available.

Class Summary

Reduce transmembrane flux of calcium via calcium channels. Cause smooth muscle relaxation, resulting in peripheral arterial vasodilation and afterload reduction. Indicated when symptoms persist despite treatment with beta-blockers or when beta-blockers are contraindicated. Also indicated in patients with Prinzmetal angina with or without nitrates.

Amlodipine (Norvasc)

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During depolarization, inhibits calcium ions from entering slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium.

Diltiazem (Cardizem CD, Dilacor)

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During depolarization, inhibits calcium ions from entering slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium.

Verapamil (Calan, Covera)

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During depolarization, inhibits calcium ion from entering slow channels or voltage-sensitive areas of vascular smooth muscle and myocardium.

Class Summary

Suitable for immediate relief of exertional or rest angina. Can also be used for prophylaxis several minutes before planned exercise to avoid angina. Reduce myocardial oxygen demand by reduction of LV and arterial pressure, primarily by reducing preload.

Nitroglycerin IV (Nitrostat, Nitro-bid, Nitrol)

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Causes relaxation of vascular smooth muscle by stimulating intracellular cyclic GMP production. Result is decrease in BP.

Class Summary

Reduce LV preload and afterload by venous and arterial dilation, which subsequently reduces myocardial oxygen consumption and relieves angina. Also cause dilation of epicardial coronary arteries, which is beneficial in patients with coronary spasm. In addition, nitroglycerin has antithrombotic and antiplatelet effects in patients with angina pectoris. No evidence suggests that nitrates improve survival or slow progression of coronary artery disease.

Isosorbide (Isordil, ISMO)

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Relaxes vascular smooth muscle by stimulating intracellular cyclic GMP. Decreases LV pressure (ie, preload) and arterial resistance (ie, afterload). Reduces cardiac oxygen demand by decreasing LV pressure and dilating arteries.

Class Summary

Angiotensin-converting enzyme (ACE) Inhibitors have been shown to reduce rates of death, MI, stroke, and need for revascularization procedures in patients with coronary artery disease or diabetes mellitus and at least one other cardiovascular risk factor,^[61] irrespective of the presence of hypertension or heart failure. The 2009 Canadian Hypertension Education Program recommends beta-blockers and ACE inhibitors as first-line therapy in patients with angina, recent myocardial infarction or heart failure.^[62]

Ramipril (Altace)

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Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion.

Class Summary

Ranolazine elicits action unlike beta-blockers, calcium antagonists, or nitrates. It does not affect hemodynamics or contractile and conduction parameters.

Ranolazine (Ranexa)

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Cardioselective anti-ischemic agent (piperazine derivative) that partially inhibits fatty acid oxidation. Also inhibits late sodium current into myocardial cells and prolongs QTc interval. Indicated for chronic angina unresponsive to other antianginal treatments. Used in combination with amlodipine, beta-blockers, or nitrates. Unlike beta-blockers, calcium channel blockers, and nitrates, does not reduce blood pressure or heart rate. Effect on angina rate or exercise tolerance appears to be smaller in women than in men. Absorption is highly variable but unaffected by food.

Questions

[Guideline] National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002 Dec 17. 106(25):3143-421. [QxMD MEDLINE Link]. [Full Text].
Losordo DW, Henry TD, Davidson C, et al. Intramyocardial, autologous CD34+ cell therapy for refractory angina. Circ Res. 2011 Aug 5. 109(4):428-36. [QxMD MEDLINE Link].
den Uil CA, Valk SD, Cheng JM, et al. Prognosis of patients undergoing cardiac surgery and treated with intra-aortic balloon pump counterpulsation prior to surgery: a long-term follow-up study. Interact Cardiovasc Thorac Surg. 2009 Aug. 9(2):227-31. [QxMD MEDLINE Link].
Campbell AR, Satran D, Zenovich AG, et al. Enhanced external counterpulsation improves systolic blood pressure in patients with refractory angina. Am Heart J. 2008 Dec. 156(6):1217-22. [QxMD MEDLINE Link].
Oesterle SN, Sanborn TA, Ali N, et al. Percutaneous transmyocardial laser revascularisation for severe angina: the PACIFIC randomised trial. Potential Class Improvement From Intramyocardial Channels. Lancet. 2000 Nov 18. 356(9243):1705-10. [QxMD MEDLINE Link].
Crea F, Pupita G, Galassi AR, et al. Role of adenosine in pathogenesis of anginal pain. Circulation. 1990 Jan. 81(1):164-72. [QxMD MEDLINE Link].
Kugiyama K, Yasue H, Okumura K, et al. Nitric oxide activity is deficient in spasm arteries of patients with coronary spastic angina. Circulation. 1996 Aug 1. 94(3):266-71. [QxMD MEDLINE Link].
Rosano GM, Collins P, Kaski JC, et al. Syndrome X in women is associated with oestrogen deficiency. Eur Heart J. 1995 May. 16(5):610-4. [QxMD MEDLINE Link].
Kaski JC, Elliott PM, Salomone O, et al. Concentration of circulating plasma endothelin in patients with angina and normal coronary angiograms. Br Heart J. 1995 Dec. 74(6):620-4. [QxMD MEDLINE Link].
Lanza GA, Giordano A, Pristipino C, et al. Abnormal cardiac adrenergic nerve function in patients with syndrome X detected by [123I]metaiodobenzylguanidine myocardial scintigraphy. Circulation. 1997 Aug 5. 96(3):821-6. [QxMD MEDLINE Link].
Deedwania PC, Carbajal EV. Silent ischemia during daily life is an independent predictor of mortality in stable angina. Circulation. 1990 Mar. 81(3):748-56. [QxMD MEDLINE Link].
Kuo L, Davis MJ, Chilian WM. Longitudinal gradients for endothelium-dependent and -independent vascular responses in the coronary microcirculation. Circulation. 1995 Aug 1. 92(3):518-25. [QxMD MEDLINE Link].
Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009 Jan 27. 119(3):e21-181. [QxMD MEDLINE Link].
Hemingway H, Langenberg C, Damant J, Frost C, Pyorala K, Barrett-Connor E. Prevalence of angina in women versus men: a systematic review and meta-analysis of international variations across 31 countries. Circulation. 2008 Mar 25. 117(12):1526-36. [QxMD MEDLINE Link].
Tanindi A, Erkan AF, Ekici B. Epicardial adipose tissue thickness can be used to predict major adverse cardiac events. Coron Artery Dis. 2015 Dec. 26 (8):686-91. [QxMD MEDLINE Link].
Li Z, Liu X, Wang J, et al. Analysis of urinary metabolomic profiling for unstable angina pectoris disease based on nuclear magnetic resonance spectroscopy. Mol Biosyst. 2015 Dec 10. 11(12):3387-96. [QxMD MEDLINE Link].
Gurses KM, Kocyigit D, Yalcin MU, et al. Enhanced platelet toll-like receptor 2 and 4 expression in acute coronary syndrome and stable angina pectoris. Am J Cardiol. 2015 Dec 1. 116(11):1666-71. [QxMD MEDLINE Link].
Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol. 2004 Aug 4. 44(3):720-32. [QxMD MEDLINE Link].
O'Keefe JH Jr, Barnhart CS, Bateman TM. Comparison of stress echocardiography and stress myocardial perfusion scintigraphy for diagnosing coronary artery disease and assessing its severity. Am J Cardiol. 1995 Apr 13. 75(11):25D-34D. [QxMD MEDLINE Link].
[Guideline] Greenland P, Bonow RO, Brundage BH, et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the So... J Am Coll Cardiol. 2007 Jan 23. 49(3):378-402. [QxMD MEDLINE Link]. [Full Text].
Kannel WB, Feinleib M. Natural history of angina pectoris in the Framingham study. Prognosis and survival. Am J Cardiol. 1972 Feb. 29(2):154-63. [QxMD MEDLINE Link].
Meijboom WB, Van Mieghem CA, van Pelt N, et al. Comprehensive assessment of coronary artery stenoses: computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina. J Am Coll Cardiol. 2008 Aug 19. 52(8):636-43. [QxMD MEDLINE Link].
Bamberg F, Truong QA, Blankstein R, et al. Usefulness of age and gender in the early triage of patients with acute chest pain having cardiac computed tomographic angiography. Am J Cardiol. 2009 Nov 1. 104(9):1165-70. [QxMD MEDLINE Link]. [Full Text].
Soran O. Alternative therapy for medically refractory angina: enhanced external counterpulsation and transmyocardial laser revascularization. Heart Fail Clin. 2016 Jan. 12(1):107-16. [QxMD MEDLINE Link].
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 Jun. 33(7):1833-40. [QxMD MEDLINE Link].
Kumar A, Aronow WS, Vadnerkar A, et al. Effect of enhanced external counterpulsation on clinical symptoms, quality of life, 6-minute walking distance, and echocardiographic measurements of left ventricular systolic and diastolic function after 35 days of treatment and at 1-year follow up in 47 patients with chronic refractory angina pectoris. Am J Ther. 2009 Mar-Apr. 16(2):116-8. [QxMD MEDLINE Link].
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 Nov 19. 344(8934):1383-9. [QxMD MEDLINE Link].
Schwartz GG, Olsson AG, Ezekowitz MD, et al. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA. 2001 Apr 4. 285(13):1711-8. [QxMD MEDLINE Link].
Sever PS, Dahlof B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomi. Lancet. 2003 Apr 5. 361(9364):1149-58. [QxMD MEDLINE Link].
Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002 Nov 23. 360(9346):1623-30. [QxMD MEDLINE Link].
LaRosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005 Apr 7. 352(14):1425-35. [QxMD MEDLINE Link].
Nissen SE, Tardif JC, Nicholls SJ, et al. Effect of torcetrapib on the progression of coronary atherosclerosis. N Engl J Med. 2007 Mar 29. 356(13):1304-16. [QxMD MEDLINE Link].
Bots ML, Visseren FL, Evans GW, et al. Torcetrapib and carotid intima-media thickness in mixed dyslipidaemia (RADIANCE 2 study): a randomised, double-blind trial. Lancet. 2007 Jul 14. 370(9582):153-60. [QxMD MEDLINE Link].
Ridker PM, Manson JE, Gaziano JM, et al. Low-dose aspirin therapy for chronic stable angina. A randomized, placebo-controlled clinical trial. Ann Intern Med. 1991 May 15. 114(10):835-9. [QxMD MEDLINE Link].
Juul-Moller S, Edvardsson N, Jahnmatz B, et al. Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina pectoris. The Swedish Angina Pectoris Aspirin Trial (SAPAT) Group. Lancet. 1992 Dec 12. 340(8833):1421-5. [QxMD MEDLINE Link].
Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001 Aug 16. 345(7):494-502. [QxMD MEDLINE Link].
Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002 Jul 17. 288(3):321-33. [QxMD MEDLINE Link].
Lacoste LL, Theroux P, Lidon RM, et al. Antithrombotic properties of transdermal nitroglycerin in stable angina pectoris. Am J Cardiol. 1994 Jun 1. 73(15):1058-62. [QxMD MEDLINE Link].
Norwegian Multicenter Study Group. Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med. 1981 Apr 2. 304(14):801-7. [QxMD MEDLINE Link].
Werdan K, Ebelt H, Nuding S, et al, for the ADDITIONS Study Investigators. Ivabradine in Combination with Metoprolol Improves Symptoms and Quality of Life in Patients with Stable Angina Pectoris: A post hoc Analysis from the ADDITIONS Trial. Cardiology. 2016. 133(2):83-90. [QxMD MEDLINE Link].
Miwa K, Miyagi Y, Igawa A, et al. Vitamin E deficiency in variant angina. Circulation. 1996 Jul 1. 94(1):14-8. [QxMD MEDLINE Link].
Kaski JC, Rosano G, Gavrielides S, Chen L. Effects of angiotensin-converting enzyme inhibition on exercise-induced angina and ST segment depression in patients with microvascular angina. J Am Coll Cardiol. 1994 Mar 1. 23(3):652-7. [QxMD MEDLINE Link].
Morice MC, Serruys PW, Sousa JE, et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med. 2002 Jun 6. 346(23):1773-80. [QxMD MEDLINE Link].
Kastrati A, Mehilli J, Pache J, et al. Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med. 2007 Mar 8. 356(10):1030-9. [QxMD MEDLINE Link].
Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. COURAGE Trial Research Group. N Engl J Med. 2007 Apr 12. 356(15):1503-16. [QxMD MEDLINE Link].
De Bruyne B, Pijls NH, Kalesan B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012 Sep 13. 367(11):991-1001. [QxMD MEDLINE Link].
Allen KB, Dowling RD, Fudge TL, et al. Comparison of transmyocardial revascularization with medical therapy in patients with refractory angina. N Engl J Med. 1999 Sep 30. 341(14):1029-36. [QxMD MEDLINE Link].
Losordo DW, Schatz RA, White CJ, et al. Intramyocardial transplantation of autologous CD34+ stem cells for intractable angina: a phase I/IIa double-blind, randomized controlled trial. Circulation. 2007 Jun 26. 115(25):3165-72. [QxMD MEDLINE Link].
Banai S, Ben Muvhar S, Parikh KH, et al. Coronary sinus reducer stent for the treatment of chronic refractory angina pectoris: a prospective, open-label, multicenter, safety feasibility first-in-man study. J Am Coll Cardiol. 2007 May 1. 49(17):1783-9. [QxMD MEDLINE Link].
[Guideline] Jellinger PS, Handelsman Y, Rosenblit PD, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract. 2017 Apr. 23 (suppl 2):1-87. [QxMD MEDLINE Link].
[Guideline] Stone NJ, Robinson JG, Lichtenstein AH, et al, American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014 Jun 24. 129(25 Suppl 2):S1-45. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Jellinger PS, Smith DA, Mehta AE, et al, for the AACE Task Force for Management of Dyslipidemia and Prevention of Atherosclerosis. American Association of Clinical Endocrinologists' Guidelines for Management of Dyslipidemia and Prevention of Atherosclerosis. Endocr Pract. 2012 Mar-Apr. 18(Suppl 1):1-78. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Jacobson TA, Ito MK, Maki KC, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: part 1 - executive summary. J Clin Lipidol. 2014 Sep-Oct. 8(5):473-88. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Fihn SD, Gardin JM, Abrams J,et al, American College of Cardiology Foundation/American Heart Association Task Force. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012 Dec 18. 126(25):e354-471. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014 Nov 4. 130(19):1749-67. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Montalescot G, Sechtem U, Achenbach S, et al, Task Force on the Management of Stable Coronary Artery Disease of the European Society of Cardiology. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013 Oct. 34(38):2949-3003. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Windecker S, Kolh P, Alfonso F, et al, for the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the Europ. 2014 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J. 2014 Oct 1. 35(37):2541-619. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the ACC/AHA Task Force on Clinical Practice Guidelines. Circulation. 2016 Sep 6. 134(10):e123-55. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Valgimigli M, Bueno H, Byrne RA, et al, for the ESC Scientific Document Group, ESC Committee for Practice Guidelines (CPG), et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018 Jan 14. 39 (3):213-60. [QxMD MEDLINE Link].
[Guideline] Shore-Lesserson L, Baker RA, Ferraris VA, et al. The Society of Thoracic Surgeons, The Society of Cardiovascular Anesthesiologists, and The American Society of ExtraCorporeal Technology: Clinical Practice Guidelines-Anticoagulation During Cardiopulmonary Bypass. Ann Thorac Surg. 2018 Feb. 105 (2):650-62. [QxMD MEDLINE Link].
Anderson HV. Angiotensin-converting enzyme inhibitors: ischemia is not the correct measure of benefit. J Am Coll Cardiol. 2003 Dec 17. 42(12):2060-2. [QxMD MEDLINE Link].
Khan NA, Hemmelgarn B, Herman RJ, et al. The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2--therapy. Can J Cardiol. 2009 May. 25(5):287-98. [QxMD MEDLINE Link]. [Full Text].
Ambrosio G, Betocchi S, Pace L, et al. Prolonged impairment of regional contractile function after resolution of exercise-induced angina. Evidence of myocardial stunning in patients with coronary artery disease. Circulation. 1996 Nov 15. 94(10):2455-64. [QxMD MEDLINE Link].
Boggs W. Coronary CT angiography, or usual care, in the ED? Medscape Medical News. February 6, 2013. Available at http://www.medscape.com/viewarticle/778873. Accessed: March 25, 2013.
Brown G, Albers JJ, Fisher LD, et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med. 1990 Nov 8. 323(19):1289-98. [QxMD MEDLINE Link].
Califf RM, Armstrong PW, Carver JR, et al. 27th Bethesda Conference: matching the intensity of risk factor management with the hazard for coronary disease events. Task Force 5. Stratification of patients into high, medium and low risk subgroups for purposes of risk factor management. J Am Coll Cardiol. 1996 Apr. 27(5):1007-19. [QxMD MEDLINE Link].
Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004 Apr 8. 350(15):1495-504. [QxMD MEDLINE Link].
Chauhan A, Mullins PA, Taylor G, et al. Both endothelium-dependent and endothelium-independent function is impaired in patients with angina pectoris and normal coronary angiograms. Eur Heart J. 1997 Jan. 18(1):60-8. [QxMD MEDLINE Link].
Connolly DC, Elveback LR, Oxman HA. Coronary heart disease in residents of Rochester, Minnesota. IV. Prognostic value of the resting electrocardiogram at the time of initial diagnosis of angina pectoris. Mayo Clin Proc. 1984 Apr. 59(4):247-50. [QxMD MEDLINE Link].
Frileux S, Munoz Sastre MT, Mullet E, Sorum PC. The impact of the preventive medical message on intention to change behavior. Patient Educ Couns. 2004 Jan. 52(1):79-88. [QxMD MEDLINE Link].
Hulten E, Pickett C, Bittencourt MS, et al. Outcomes after coronary computed tomography angiography in the emergency department: a systematic review and meta-analysis of randomized, controlled trials. J Am Coll Cardiol. 2013 Feb 26. 61(8):880-92. [QxMD MEDLINE Link].
Khan NE, De Souza A, Mister R, et al. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med. 2004 Jan 1. 350(1):21-8. [QxMD MEDLINE Link].
Margolis JR, Chen JT, Kong Y, et al. The diagnostic and prognostic significance of coronary artery calcification. A report of 800 cases. Radiology. 1980 Dec. 137(3):609-16. [QxMD MEDLINE Link].
Mark DB, Califf RM, Morris KG, et al. Clinical characteristics and long-term survival of patients with variant angina. Circulation. 1984 May. 69(5):880-8. [QxMD MEDLINE Link].
Maseri A, Crea F, Kaski JC, Davies G. Mechanisms and significance of cardiac ischemic pain. Prog Cardiovasc Dis. 1992 Jul-Aug. 35(1):1-18. [QxMD MEDLINE Link].
Piatti P, Fragasso G, Monti LD, et al. Endothelial and metabolic characteristics of patients with angina and angiographically normal coronary arteries: comparison with subjects with insulin resistance syndrome and normal controls. J Am Coll Cardiol. 1999 Nov 1. 34(5):1452-60. [QxMD MEDLINE Link].
Rocco MB, Nabel EG, Campbell S, et al. Prognostic importance of myocardial ischemia detected by ambulatory monitoring in patients with stable coronary artery disease. Circulation. 1988 Oct. 78(4):877-84. [QxMD MEDLINE Link].
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. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group. N Engl J Med. 1999 Aug 5. 341(6):410-8. [QxMD MEDLINE Link].
Wenger NK, Speroff L, Packard B. Cardiovascular health and disease in women. N Engl J Med. 1993 Jul 22. 329(4):247-56. [QxMD MEDLINE Link].
Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000 Jan 20. 342(3):145-53. [QxMD MEDLINE Link].
Kovarnik T, Chen Z, Mintz GS, et al. Plaque volume and plaque risk profile in diabetic vs. non-diabetic patients undergoing lipid-lowering therapy: a study based on 3D intravascular ultrasound and virtual histology. Cardiovasc Diabetol. 2017 Dec 7. 16(1):156. [QxMD MEDLINE Link].
Konigstein M, Giannini F, Banai S. The Reducer device in patients with angina pectoris: mechanisms, indications, and perspectives. Eur Heart J. 2017 Aug 31. [QxMD MEDLINE Link].
Her AY, Kim YH, Garg S, Shin ES. Impact of paclitaxel-coated balloon versus newer-generation drug-eluting stent on periprocedural myocardial infarction in stable angina patients. Coron Artery Dis. 2018 Aug. 29 (5):403-8. [QxMD MEDLINE Link].
Bu Z, Ma J, Fan Y, et al. Ascending aortic strain analysis using 2-dimensional speckle tracking echocardiography improves the diagnostics for coronary artery stenosis in patients With suspected stable angina pectoris. J Am Heart Assoc. 2018 Jul 7. 7 (14):[QxMD MEDLINE Link].
Okada H, Tada H, Hayashi K, et al. Aortic root calcification score as an independent factor for predicting major adverse cardiac events in familial hypercholesterolemia. J Atheroscler Thromb. 2018 Jul 1. 25 (7):634-42. [QxMD MEDLINE Link].
Demirtas AO, Karabag T, Demirtas D. Ischemic modified albumin predicts critical coronary artery disease in unstable angina pectoris and non-ST-elevation myocardial infarction. J Clin Med Res. 2018 Jul. 10 (7):570-5. [QxMD MEDLINE Link].

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Author

Jamshid Alaeddini, MD, FACC, FHRS Director, Cardiac Electrophysiology Services, Lake Health System

Jamshid Alaeddini, MD, FACC, FHRS is a member of the following medical societies: American College of Cardiology, American Heart Association, Heart Rhythm Society

Disclosure: Nothing to disclose.

Coauthor(s)

Jamshid Shirani, MD Director of Cardiology Fellowship Program, Director of Echocardiography Laboratory, Director of Hypertrophic Cardiomyopathy Clinic, St Luke's University Health Network

Jamshid Shirani, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society of Echocardiography, Association of Subspecialty Professors, American College of Cardiology, American College of Physicians, American Heart Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Yasmine S Ali, MD, MSCI, FACC, FACP Assistant Clinical Professor of Medicine, Vanderbilt University School of Medicine; President, LastSky Writing, LLC

Yasmine S Ali, MD, MSCI, FACC, FACP is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Medical Writers Association, National Lipid Association, Tennessee Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: LastSky Writing;Philips Healthcare;M Health;Athena Health;PeerView Institute;Verywell Health; HealthCentral;MedEdicus;Pharmaceutical Training Institute;Elsevier;MedStudy;North American Thrombosis Forum;WellnessVerge;Prose Media; AKH, Inc.<br/>Serve(d) as a speaker or a member of a speakers bureau for: North American Thrombosis Forum.

Chief Editor

Eric H Yang, MD Associate Professor of Medicine, Director of Cardiac Catherization Laboratory and Interventional Cardiology, Mayo Clinic ArizonA

Eric H Yang, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Angina Pectoris Medication

Medication Summary

Antiplatelet agents

Class Summary

Aspirin (Anacin, Ascriptin, Bayer Aspirin, Bayer Buffered Aspirin)

Aspirin (Anacin, Ascriptin, Bayer Aspirin, Bayer Buffered Aspirin)

Clopidogrel (Plavix)

Clopidogrel (Plavix)

Beta-adrenergic blocking agents

Class Summary

Metoprolol (Lopressor, Toprol XL)

Metoprolol (Lopressor, Toprol XL)

Atenolol (Tenormin)

Atenolol (Tenormin)

Propranolol (Inderal)

Propranolol (Inderal)

Calcium channel blockers

Class Summary

Amlodipine (Norvasc)

Amlodipine (Norvasc)

Diltiazem (Cardizem CD, Dilacor)

Diltiazem (Cardizem CD, Dilacor)

Verapamil (Calan, Covera)

Verapamil (Calan, Covera)

Short-acting nitroglycerins

Class Summary

Nitroglycerin IV (Nitrostat, Nitro-bid, Nitrol)

Nitroglycerin IV (Nitrostat, Nitro-bid, Nitrol)

Long-acting nitroglycerins

Class Summary

Isosorbide (Isordil, ISMO)

Isosorbide (Isordil, ISMO)

Angiotensin-converting enzyme inhibitors

Class Summary

Ramipril (Altace)

Ramipril (Altace)

Anti-ischemic agents, miscellaneous

Class Summary

Ranolazine (Ranexa)

Ranolazine (Ranexa)

Angina Pectoris Medication

Medication Summary

Antiplatelet agents

Class Summary

Aspirin (Anacin, Ascriptin, Bayer Aspirin, Bayer Buffered Aspirin)

Clopidogrel (Plavix)

Beta-adrenergic blocking agents

Class Summary

Metoprolol (Lopressor, Toprol XL)

Atenolol (Tenormin)

Propranolol (Inderal)

Calcium channel blockers

Class Summary

Amlodipine (Norvasc)

Diltiazem (Cardizem CD, Dilacor)

Verapamil (Calan, Covera)

Short-acting nitroglycerins

Class Summary

Nitroglycerin IV (Nitrostat, Nitro-bid, Nitrol)

Long-acting nitroglycerins

Class Summary

Isosorbide (Isordil, ISMO)

Angiotensin-converting enzyme inhibitors

Class Summary

Ramipril (Altace)

Anti-ischemic agents, miscellaneous

Class Summary

Ranolazine (Ranexa)

References

Tables

Contributor Information and Disclosures

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