Medical Therapy
Medical therapy is indicated in our patient because he is clinically stable, with no change in his symptoms of angina pectoris over the last year. He also has a normal resting electrocardiogram, and his exercise stress test demonstrated no high risk variables. However, he has several untreated risk factors, and his response should be closely monitored to determine if further study or therapy is indicated.
The treatment of all patients with stable angina pectoris should begin with an effort to control coronary risk factors, eliminate symptoms, prevent future coronary events, and prolong survival.
The management of patients with atherosclerotic disease entails treatment of major coronary risk factors. This includes the cessation of smoking, achieving an ideal body weight, and the control of hypertension, diabetes and hyperlipidemia. It also includes an appropriate program of aerobic exercise.
Additional risk factors for atherosclerotic disease have been identified, although their therapeutic implications have not been clearly defined. These include increased high-sensitivity C-reactive protein, the presence of small LDL particles, elevated lipoprotein A - Lp(a), and the metabolic syndrome. The metabolic syndrome is defined as the concurrence of the following metabolic risk factors: abdominal obesity, hyperglycemia, dyslipidemia and hypertension.
In patients with coronary artery disease, aspirin decreases coronary events, including myocardial infarction and sudden death. All patients with stable angina should be given aspirin in the absence of contraindications.