MANAGEMENT OF STABLE ANGINA-EUROPEAN, CANADIAN, BRITISH AND AMERICAN SCIENTIFIC SOCIETY GUIDELINES: A CRITICAL APPRAISAL
Udho Thadani, M.D., OUHSC; Medical Center and VA Medical Center Oklahoma City, OK, USA
Patients with stable angina Pectoris (SAP) seek medical advice primarily for symptom relief and for fear of having a heart attack or dying suddenly. Clinical Guidelines from different countries to treat SAP vary considerably. Guidelines for treating SAP have been derived from randomized clinical trials in patients with documented coronary artery disease (CAD). Despite these facts, current Guidelines do not recommend routine coronary angiography initially, but recommend optimal medical treatment with two or more antianginal medications prior to considering revascularization. Selection of initial class of antianginal drug in the current guidelines is not based on evidence, but is mostly opinion based, as there is lack of data showing that any of the available antianginal medications improve survival in patients with SAP; or that one class of antianginal drug is superior to another class for symptom relief. In the American Society Guidelines, it is recommended that all patients with stable ischemic heart disease, irrespective of the presence or absence of CAD should also be treated with aspirin and a potent statin. In contrast, Guidelines from other countries recommend that patients with CAD should be treated with antianginal drugs and aspirin, and an angiotensin receptor blocker, but the dose of a statin should be titrated to a desirable LDL level. Recommendations for treating patients with SAP who have normal coronary arteries are not evidence based in any of the guidelines.