The underlying pathophysiological mechanisms encompass a range of factors, including atherosclerosis in epicardial coronary arteries, vasospasm in large or small vessels, and microvascular dysfunction—whose clinical significance is increasingly acknowledged.
While there is consensus on the prognostic importance of lifestyle interventions and preventive measures like aspirin and statin therapy, determining the optimal antianginal treatment for chronic coronary syndrome patients remains less defined.
The majority of individuals experiencing stable angina can effectively address their condition through lifestyle modifications, particularly by embracing smoking cessation and incorporating regular exercise into their routine.
However, findings from randomized controlled trials reveal that the efficacy of various antianginal drugs is comparable, with none demonstrating a significant reduction in mortality or the risk of myocardial infarction (MI).
In a parallel vein, the National Institute for Health and Care Excellence (NICE) guidelines for stable angina management consider cost-effectiveness in their recommendations, designating terms such as first-line and second-line therapy.
By delving into the nuances of these recommendations, we seek to provide a comprehensive understanding of the rationale behind the suggested pharmacological interventions for stable angina, shedding light on their respective strengths and considerations in clinical practice.
[1] The 2019 guidelines from the European Society of Cardiology (ESC) advocate for a personalized approach in which antianginal medications are tailored to an individual patient's comorbidities and hemodynamic profile.