Management of stable angina pectoris and of other chronic cardiovascular arterial diseases

Czech version

Authors: P. Gavornik; A. Dukát; Ľ. Gašpar
Authors‘ workplace: II. interná klinika Lekárskej fakulty UK a UN Bratislava, Prvé angiologické pracovisko (PAP), Slovenská republika, prednosta prof. MUDr. Ľudovít Gašpar, CSc.
Published in: Vnitř Lék 2012; 58(7 a 8): 29-36
Category: 80th Birthday MUDr. Miroslav Mydlík, DrSc.

Overview

The aim of this document of the Angiologists’ Section of the Slovak Medical Chamber (AS SMC) is to address a member studies on stable angina pectoris published in the last 5 years in order to assess their contribution to our expanding knowledge of chronic cardiovascular arterial diseases. The prevalence of angina pectoris, according to the European Society of Cardiology (ESC), is from 2–5% (men, 45–54 years-old) to 10–20% (men, 65–74 years-old) and from 0,1–1% (women, 45–54 years-old) to 10–15% (women, 65–74 years-old). During the last decade there has been a shift of these patients to a higher age group. As a result of the increased age of Europeans there is a global increase of prevalence of stable angina pectoris. This vascular illness influences mainly the quality of the patient’s life, morbidity, premature invalidity and mortality. The authors have analysed the clinical-etiology-anatomy-pathophysiology problems in patients with stable angina pectoris: lack of satisfactory pharmacotherapy, persistence of angina symptoms after revascularization, impossible revascularization in some patients, and also the poor tolerance of pharmacotherapy in others. They have focused attention mainly on treatment strategies influencing the prognosis of the patient (antithrombotics, beta-blockers, statins, ACE inhibitors) and the quality of life (calcium channel blockers, nitrates, nicorandil, trimetazidine, ranolazine, ivabradine etc.). Non-pharmacotherapy should not be forgotten, either. It is useful for the prevention of progression of cardiovascular arterial disease to diagnose it and to start early the treatment of angina pectoris. In this way we may improve the patient‘s prognosis and quality of life.

Key words:
stable angina pectoris – chronic cardiovascular arterial diseases – organovascular arterial diseases – management

Sources

1. Fox K, Garcia MAA, Ardissino D et al. Guidelines on the management on stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 2006; 27: 1341–1381.

2. Gavorník P. Manažment stabilnej anginy pectoris. Medikom/Medinews 2011; 1: 12–14.

3. Gavorník P. Obliterujúce choroby artérií a končatinovocievna ischemická choroba. Nová klinicko-etiologicko-anatomicko-patofyziologická (CEAP) klasifikácia. Cardiology 2010; 19: 201–213.

4. Hamm CW, Bassand JP, Agewall S et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011; 32(23): 2999–3054.

5. Van de Werf F, Bax J, Betriu A et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 2008; 29: 2909–2945.

6. Gavorník P. Nevyhnutnosť neustáleho prehodnocovania manažmentu artériovej hypertenzie ako cievnej choroby cievnych chorôb. Medikom/Medinews 2011; 1: 12–13.

7. Gavorník P. Artériotromboprofylaxia v klinickej praxi. Cardiology 2010; 19: 293–299.

8. Reiner Ž, Catapano AL, De Backer G et al. ESC/EAS Guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011; 32: 1769–1818.

9. Chapman MJ, Ginsberg NH, Amarenco P et al. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management. Eur Heart J 2011; 32: 1345–1361.

10. Rydén L, Standl E, Bartnik M et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J 2007; 28: 88–136.

11. Gavorník P. Aktuálne odporúčania pre manažment fibrilácie predsiení a jej systémových artériových tromboembolických komplikácií. Medikom/Medinews 2011; 1: 12–14.

12. Diskstein K, Cohen-Solal A, Filippatos G et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 29: 2388–2442.

13. Regitz-Zagrosek V, Lundquist CB, Borghi C et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: The Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart 2011; 32(24): 3149–3197.

14. Gavorník P. Etiopatogenéza neurovaskulárnych ischemických chorôb (syndrómov). Neurológia 2010; 5: 61–68.

15. Tendera M, Aboyans V, Bartelink ML et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. The Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 2011; 32(22): 2851–2906.

16. Gavorník P. Končatinovocievne ischemické choroby. B 2.1: 1–92. In: Gavorník P, Hrubiško M, Rozborilová E (eds). Diferenciálna diagnostika kardio-vaskulárnych, respiračných a hematologických ochorení. I. Bratislava: Dr. Josef Raabe 2010.

17. Kotík L. Snížení morbidity a mortality nemocných s chronickými formami ischemické choroby srdeční je výsledkem konzervativní léčby. Vnitř Lék 2011; 57: 497–501.

18. Cífková R. Co způsobuje pokles úmrtnosti na ischemickou chorobu srdeční? – editorial. Vnitř Lék 2011; 57: 435–436.

19. Groch L. Co způsobuje pokles úmrtnosti na ischemickou chorobu srdeční? – editorial. Vnitř Lék 2011; 57: 437–438.

20. Špinar J, Vítovec J, Špinarová L. FARIM – FARmakoterapie po Infarktu Myokardu. Vnitř Lék 2011; 57: 778–784.

21. Wijns W, Kolh Ph, Danchin N et al. Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2010; 31: 2501–2555.

22. Mack MJ, Feldman TE, Kappetein AP et al. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. Eur Heart J 2011; 32: 2125–2134.

23. Graham I, Atar D, Borch-Johnsen K et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts). Eur Heart J 2007; 28: 2375–2414.

24. Banegas JR, López-Garcia E, Dallongeville J et al. Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: the EURIKA study. Eur Heart J 2011; 32: 2143–2152.

25. Smith jr. SC, Benjamin EJ, Bonow RO et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update. A Guideline From the American Heart Association and American College of Cardiology Foundation. J Am Coll Cardiol 2011; 58(23): 2432–2446.

26. Rooke TW, Hirsch AT, Misra S et al. 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline). A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 58: 2020–2045.

27. Swedberg K, Komajda M, Böhm M et al. Rationale and design of a randomized, double-blind, placebo-controled outcome trial of ivabradine in chronic heart failure: the Systolic Heart Failure Treatment with the If Inhibitor Ivabradine Trial (SHIFT). Eur J Heart Fail 2010; 12: 75–81.

28. Ekman I, Chassany O, Komajda M et al. Heart rate reduction with ivabradine and health related quality of life in patients with chronic heart failure: results from the SHIFT study. Eur Heart J 2011; 32: 2395–2404.

29. Tardif JC, ÓMeara E, Komajda M et al. Effects of selective heart rate reduction with ivabradine on the left ventricular remodeling and function: results from the SHIFT echocardiographic substudy. Eur Heart J 2011; 32: 2507–2515.

30. Ip JH, Fuster V, Badimon L et al. Syndromes of accelerated atherosclerosis: Role of vascular injury and smooth muscle cell proliferation. J Amer Coll Cardiol 1990; 15: 1667–1687.