Pharmacy Times

An Update on Pharmacologic Treatment of Chronic Stable Angina

Author: Mohammad J. Tafreshi, PharmD, BCPS, and Mark S. LaBash, PharmD


    It is estimated that more than 6 million Americans suffer from chest pain and discomfort. The American Heart Association (AHA) estimates that in the United States there are 400,000 newly diagnosed stable angina cases each year. Furthermore, it is estimated that the annual costs associated with chronic stable angina are measured in the 10s of billions of dollars.1

    Recently, the AHA, in association with the American College of Cardiology (ACC), published updated guidelines for the management of patients with chronic stable angina. Treatment of asymptomatic patients?ie, patients with silent ischemia showing abnormal noninvasive test results or patients with known coronary artery disease (CAD)?also are included in these guidelines.1

Recommendation Classifications and Levels of Evidence

    The customary ACC/AHA classifications (I, IIa, IIb, and III) and levels of evidence (A, B, and C) are used in these guidelines:

Treatment of Patients with Chronic Stable Angina

    The Table includes a comparison of the old and new guidelines. The modifications are indicated in bold.

Treatment of Asymptomatic Patients

    Treatment of asymptomatic patients is an addition; it was not included in the old guidelines.

Class I

Class IIa

Coronary Disease Risk Factors and Evidence That Treatment Can Reduce the Risk for Coronary Disease Events

    The following are recommendations for the treatment of risk factors.

Class I

Class IIa

Class III


The new guidelines have treatment strategies for adult patients with symptomatic and asymptomatic chronic stable angina. Changes include the use of beta-blockers for more patients, the use of ACE inhibitors, comments on the dose of aspirin, changes to lipid-lowering therapy, and the inclusion of treatment for asymptomatic chronic stable angina patients.

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