Controversies in stable coronary artery disease

Lancet. 2006 Jan 7;367(9504):69-78. doi: 10.1016/S0140-6736(06)67927-0.


Coronary heart disease is still highly prevalent worldwide, and stable angina pectoris is one of its more common presentations. Three major controversies are risk factor management, drug therapy, and intervention. As well as the major risk factors stated by the Framingham study and European guidelines, other factors include abdominal obesity, metabolic syndrome, and psychological stress. How should these additional factors be rated? With respect to drug therapy, apart from aspirin, all patients with stable angina should be assessed for statin treatment. Although statins will reduce coronary events by about one third in patients with vascular disease, the absolute benefit depends on the absolute risk. Non-controversially, all patients should be considered for angiotensin-converting-enzyme inhibitors. The concept that beta blockers are protective from future coronary events can be disputed. Percutaneous coronary intervention can relieve symptoms without extending lifespan beyond medical therapy. However, strong mortality data favour coronary-artery bypass grafting in individuals with triple-vessel or even double-vessel disease. Thus, effort angina needs comprehensive assessment, lifestyle changes, and treatment tailored to the individual patient.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Angina Pectoris* / drug therapy
  • Angina Pectoris* / etiology
  • Angina Pectoris* / surgery
  • Angioplasty, Balloon, Coronary
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Attitude of Health Personnel*
  • Child
  • Coronary Artery Bypass*
  • Diabetes Mellitus, Type 2 / complications
  • Diet*
  • Exercise
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Life Style*
  • Metabolic Syndrome / complications
  • Risk Factors
  • Tobacco Smoke Pollution / adverse effects*


  • Angiotensin-Converting Enzyme Inhibitors
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Tobacco Smoke Pollution