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

Controversies in Stable Coronary Artery Disease

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Review

Controversies in Stable Coronary Artery Disease

Lionel H Opie et al. Lancet. .

Abstract

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.

Comment in

  • Controversies in cardiology.
    Taggart DP. Taggart DP. Lancet. 2006 Apr 22;367(9519):1313; author reply 1315-6. doi: 10.1016/S0140-6736(06)68566-8. Lancet. 2006. PMID: 16631900 No abstract available.
  • Controversies in cardiology.
    Coca SG. Coca SG. Lancet. 2006 Apr 22;367(9519):1313; author reply 1315-6. doi: 10.1016/S0140-6736(06)68567-X. Lancet. 2006. PMID: 16631901 No abstract available.
  • Controversies in cardiology.
    He FJ, de Wardener HE, MacGregor GA. He FJ, et al. Lancet. 2006 Apr 22;367(9519):1313-4; author reply 1315-6. doi: 10.1016/S0140-6736(06)68568-1. Lancet. 2006. PMID: 16631902 No abstract available.

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