Contemporary management of patients with stable ischemic heart disease

In the current issue of Cardiovascular Innovations and Applications (Special Issue on Stable Ischemic Heart Disease, Volume 3, Number 3, 2019, pp. 269-278(10); DOI https://doi.org/10.15212/CVIA.2017.0071, Radmila Lyubarova, Joshua Schulman-Marcus and William E. Boden from the Division of Cardiology, Department of Medicine, Albany Medical Center, Albany, NY, USA and VA New England Healthcare System, Boston, MA, USA consider contemporary management of patients with stable ischemic heart disease.

Angina persists for many patients despite medical therapy and/or revascularization. In all patients with angina, aggressive risk factor modification and optimized medical management must be instituted. Revascularization should be performed for high-risk patients or patients with persistent symptoms. A beta-blocker is likely a first-line agent; how-ever, most patients require multiple medications for symptom control. Novel agents with new mechanisms improve treatment options, including ivabradine (sinus node inhibitor), and late Na+blockade (with a mechanism of action complementary to traditional agents) is beneficial in a broad range of patients unresponsive to current treatment options. Ongoing trials may help better define the role of aggressive medical therapy with or without revascularization.

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