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16.09.2016 | ORIGINAL ARTICLE

Management of Stable Angina – Current Guidelines: A Critical Appraisal

verfasst von: Udho Thadani

Erschienen in: Cardiovascular Drugs and Therapy | Ausgabe 4/2016

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Abstract

Guidelines provide recommendations to improve patient outcomes, but many of the recommendations made for treating patients with stable angina are opinion based rather than evidence based. Risk stratification to predict patients at an increased risk of myocardial infarction (MI) and sudden ischemic death, and selection of patients for possible revascularization, is based on expert opinion. Randomized trials have compared optimal medical therapy to revascularization, after the coronary anatomy was known, and yet routine coronary angiography to exclude left main disease is not recommended. What exactly is optimal antianginal treatment varies considerably from one country’s guideline recommendations to another. None of the antianginal drugs reduce mortality or MI and these drugs are equally effective in treating angina pectoris; and yet beta-blockers and calcium channel blockers are recommended as first line therapy. Double and triple therapy with different classes of antianginal drugs is also expert opinion based rather than evidence based. Recommendations to reduce the incidence of MI and sudden death are appropriate; however the use of a potent, high dose statin, is recommended by AHA/ACC and NICE guidelines for all patients with ischemic heart disease, while the European guidelines recommend a target LDL goal in patients with coronary artery disease (CAD). Management of patients with stable angina pectoris with normal coronary arteries remains ambiguous. This short review critically appraises the recommendations for managing patients with stable angina pectoris.
Literatur
1.
Zurück zum Zitat Heberden W. Some account of a disorder of the breast. Medical transitions. Royal College of Physicians; 1772. Heberden W. Some account of a disorder of the breast. Medical transitions. Royal College of Physicians; 1772.
2.
Zurück zum Zitat Thadani U. Current medical management of chronic stable angina pectoris. J Cardiovasc Pharmacol Ther 2004;9 (supplement 1) S11–s29. Thadani U. Current medical management of chronic stable angina pectoris. J Cardiovasc Pharmacol Ther 2004;9 (supplement 1) S11–s29.
3.
Zurück zum Zitat Opie LH. Angina pectoris: the evolution of concepts. J Cardiovasc Pharmacol Ther. 2004;9(Suppl 1):S3–9.CrossRefPubMed Opie LH. Angina pectoris: the evolution of concepts. J Cardiovasc Pharmacol Ther. 2004;9(Suppl 1):S3–9.CrossRefPubMed
4.
Zurück zum Zitat Abrams J, Thadani U. Therapy of stable angina pectoris: the uncomplicated patient. Circulation. 2005;112:e255–9.CrossRefPubMed Abrams J, Thadani U. Therapy of stable angina pectoris: the uncomplicated patient. Circulation. 2005;112:e255–9.CrossRefPubMed
5.
Zurück zum Zitat Fraker TD, Fihn ST, et al. 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina. Circulation. 2007;116:2762–72.CrossRefPubMed Fraker TD, Fihn ST, et al. 2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina. Circulation. 2007;116:2762–72.CrossRefPubMed
6.
Zurück zum Zitat Fihn SD, Garlin JM, Abrams J, et al. ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guidelines for the diagnosis and management of patients with stable ischemic heart disease. Circulation. 2012;126:e354–471.CrossRefPubMed Fihn SD, Garlin JM, Abrams J, et al. ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guidelines for the diagnosis and management of patients with stable ischemic heart disease. Circulation. 2012;126:e354–471.CrossRefPubMed
7.
Zurück zum Zitat Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS focused update of the guidelines for the diagnosis and management of patients with stable ischemic heart disease. Circulation. 2014;130:1749–67.CrossRefPubMed Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS focused update of the guidelines for the diagnosis and management of patients with stable ischemic heart disease. Circulation. 2014;130:1749–67.CrossRefPubMed
8.
Zurück zum Zitat Montalesscot G, Sechtem U, Achenbachm S, et al. 2013 ESC guidelines for the management of stable coronary artery disease. Eur Heart J. 2013;34:2949–3003.CrossRef Montalesscot G, Sechtem U, Achenbachm S, et al. 2013 ESC guidelines for the management of stable coronary artery disease. Eur Heart J. 2013;34:2949–3003.CrossRef
9.
Zurück zum Zitat Mancini GBJ, Gosselin G, Chow B, et al. Canadian cardiovascular society guidelines for the diagnosis and management of stable ischemic heart disease. Can J Cardiol. 2014;30:837–49.CrossRefPubMed Mancini GBJ, Gosselin G, Chow B, et al. Canadian cardiovascular society guidelines for the diagnosis and management of stable ischemic heart disease. Can J Cardiol. 2014;30:837–49.CrossRefPubMed
10.
Zurück zum Zitat Thadani U. The pursuit of optimum outcomes in stable angina. Am J Cardiovasc Drugs 2003; (Suppl 1); pp 11–20. Thadani U. The pursuit of optimum outcomes in stable angina. Am J Cardiovasc Drugs 2003; (Suppl 1); pp 11–20.
11.
Zurück zum Zitat Thadani U. Management of patients with chronic stable angina at low risk for serious cardiac events. Am J Cardiol. 1997;80:421–5.CrossRefPubMed Thadani U. Management of patients with chronic stable angina at low risk for serious cardiac events. Am J Cardiol. 1997;80:421–5.CrossRefPubMed
12.
Zurück zum Zitat Braunwald E, Sobel, B. Coronary blood flow and myocardial ischemia: In Braunwald E, edition, Heart Disease a Textbook of Cardiovascular Medicine, Philadelphia, PA, WB Saunders, 1191, 1998. Braunwald E, Sobel, B. Coronary blood flow and myocardial ischemia: In Braunwald E, edition, Heart Disease a Textbook of Cardiovascular Medicine, Philadelphia, PA, WB Saunders, 1191, 1998.
13.
Zurück zum Zitat Thadani U, Fung HL, Darke AC, et al. Oral isosorbide dinitrate in angina pectoris: comparison of duration of action and dose-response relation during acute and sustained therapy. Am J Cardiol. 1982;49:411–9.CrossRefPubMed Thadani U, Fung HL, Darke AC, et al. Oral isosorbide dinitrate in angina pectoris: comparison of duration of action and dose-response relation during acute and sustained therapy. Am J Cardiol. 1982;49:411–9.CrossRefPubMed
14.
Zurück zum Zitat Thadani U, Lipiky R. Short and long-acting oral nitrates for stable angina. Cardiovasc Drugs Ther. 1994;8:611–23.CrossRefPubMed Thadani U, Lipiky R. Short and long-acting oral nitrates for stable angina. Cardiovasc Drugs Ther. 1994;8:611–23.CrossRefPubMed
15.
Zurück zum Zitat Thadani U, Lipicky R. Ointments and transdermal nitroglycerin patches for stable angina. Cardiovasc Drugs Ther. 8:625–33. Thadani U, Lipicky R. Ointments and transdermal nitroglycerin patches for stable angina. Cardiovasc Drugs Ther. 8:625–33.
16.
Zurück zum Zitat Thadani U. Challenges with nitrate therapy and nitrate tolerance: prevalence, prevention, and clinical relevance Am J Cardiovasc Drugs 2014;14 (40):287–301. Thadani U. Challenges with nitrate therapy and nitrate tolerance: prevalence, prevention, and clinical relevance Am J Cardiovasc Drugs 2014;14 (40):287–301.
17.
Zurück zum Zitat Chrysant SG, Glasser SP, Bittar N, et al. Efficacy and safety of extended-release isosorbide-5-mononitrate in angina pectoris. Am J Cardiol. 1993;72:1249–56.CrossRefPubMed Chrysant SG, Glasser SP, Bittar N, et al. Efficacy and safety of extended-release isosorbide-5-mononitrate in angina pectoris. Am J Cardiol. 1993;72:1249–56.CrossRefPubMed
18.
Zurück zum Zitat DeMots H, Glasser SP. On behalf of the Transderm-nitro trial study group. Intermittent transdermal nitroglycerin therapy in the treatment of chronic stable angina. JACC. 1989;13:786–93.CrossRefPubMed DeMots H, Glasser SP. On behalf of the Transderm-nitro trial study group. Intermittent transdermal nitroglycerin therapy in the treatment of chronic stable angina. JACC. 1989;13:786–93.CrossRefPubMed
19.
Zurück zum Zitat Huang HL, Fox KA. The impact of beta-blockers on mortality instable angina: a meta-analysis. Scott Med J. 2012;57:69–75.CrossRefPubMed Huang HL, Fox KA. The impact of beta-blockers on mortality instable angina: a meta-analysis. Scott Med J. 2012;57:69–75.CrossRefPubMed
20.
Zurück zum Zitat Banglore S, Steg G, Deedwania P, et al. Beta-blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. JAMA. 2012;308:1340–9.CrossRef Banglore S, Steg G, Deedwania P, et al. Beta-blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. JAMA. 2012;308:1340–9.CrossRef
21.
Zurück zum Zitat Heidenreich PA, McDonald KM, Hastie et al. Meta-analysis of trials comparing beta-blockers, calcium antagonists, and nitrates for stable angina. JAMA 1999;281:1927–1936 Heidenreich PA, McDonald KM, Hastie et al. Meta-analysis of trials comparing beta-blockers, calcium antagonists, and nitrates for stable angina. JAMA 1999;281:1927–1936
22.
Zurück zum Zitat The IONA Study Group. Effect of nicorandil on coronary events in patients with stable angina: the Impact of Nicorandil in angina (IONA) randomized trial. Lancet 2002:359:1269–1275. The IONA Study Group. Effect of nicorandil on coronary events in patients with stable angina: the Impact of Nicorandil in angina (IONA) randomized trial. Lancet 2002:359:1269–1275.
23.
Zurück zum Zitat Hughes LO, El R, Lahiri A, et al. Comparison of nicorandil and atenolol in stable angina pectoris. Am J Cardiol. 1990;66:679–82.CrossRefPubMed Hughes LO, El R, Lahiri A, et al. Comparison of nicorandil and atenolol in stable angina pectoris. Am J Cardiol. 1990;66:679–82.CrossRefPubMed
24.
Zurück zum Zitat Thadani U. Can nicorandil treat angina pectoris effectively / Nature Clin Pract Cardio Med 2005 2: 186–187. Thadani U. Can nicorandil treat angina pectoris effectively / Nature Clin Pract Cardio Med 2005 2: 186–187.
25.
Zurück zum Zitat Chaitman BR, Skettino S, Parker JO, et al. MARISA investigators. Anti-ischemic effects and long-term survival during ranolazine monotherapy in patients with chronic severe angina. J Am Coll Cardiol. 2004;43:1375–82.CrossRefPubMed Chaitman BR, Skettino S, Parker JO, et al. MARISA investigators. Anti-ischemic effects and long-term survival during ranolazine monotherapy in patients with chronic severe angina. J Am Coll Cardiol. 2004;43:1375–82.CrossRefPubMed
26.
Zurück zum Zitat Chaitman BR, Pepine J, Parker JO, et al. Effects of ranolazine with atenolol,, amlodipine or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina; the CARISA study Group. JAMA. 2004;291:309–16.CrossRefPubMed Chaitman BR, Pepine J, Parker JO, et al. Effects of ranolazine with atenolol,, amlodipine or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina; the CARISA study Group. JAMA. 2004;291:309–16.CrossRefPubMed
27.
Zurück zum Zitat Stone PH, Gratsiansky NA, Blokhin A, et al. Antianginal efficacy of ranolazine when added to treatment with amlodipine: the ERICA (efficacy of ranolazine in chronic angina trial. J Am Coll Cardiol. 2006;48:566–75.CrossRefPubMed Stone PH, Gratsiansky NA, Blokhin A, et al. Antianginal efficacy of ranolazine when added to treatment with amlodipine: the ERICA (efficacy of ranolazine in chronic angina trial. J Am Coll Cardiol. 2006;48:566–75.CrossRefPubMed
28.
Zurück zum Zitat Kosiborod M, Arnold S, Spertus J, et al. Evaluation of ranolazine in patients with type 2 diabetes and chronic stable angina: results from the TERISSA randomized clinical trial (Type 2 diabetes evaluation in ranolazine subjects with chronic stable angina). J Am Coll Cardiol. 2013;61:2083–45.CrossRef Kosiborod M, Arnold S, Spertus J, et al. Evaluation of ranolazine in patients with type 2 diabetes and chronic stable angina: results from the TERISSA randomized clinical trial (Type 2 diabetes evaluation in ranolazine subjects with chronic stable angina). J Am Coll Cardiol. 2013;61:2083–45.CrossRef
29.
Zurück zum Zitat Weisz G, Genereux P, Lniguez A, Zurakowski A, Schechter M, Alexander KP, Dressler O, Osmukhina A, James S, Magnus O, Ben-Yehuda O, Farzaneh-Far R, Stone GW, for the RIVER-PCI investigators. Ranolazine in patients with incomplete revascularisation after percutaneous coronary intervention (RIVER-PCI): A multicenter, randomized, double-blind, placebo-controlled trial. Lancet 2016;387:136–145 Weisz G, Genereux P, Lniguez A, Zurakowski A, Schechter M, Alexander KP, Dressler O, Osmukhina A, James S, Magnus O, Ben-Yehuda O, Farzaneh-Far R, Stone GW, for the RIVER-PCI investigators. Ranolazine in patients with incomplete revascularisation after percutaneous coronary intervention (RIVER-PCI): A multicenter, randomized, double-blind, placebo-controlled trial. Lancet 2016;387:136–145
30.
Zurück zum Zitat Thadani U. Should ranolazine be used for all patients with ischemic heart disease or only symptomatic patients with stable angina or those with refractory angina pectoris. Expert Opin Pharmacother. 2012;13(17):2555–63.CrossRefPubMed Thadani U. Should ranolazine be used for all patients with ischemic heart disease or only symptomatic patients with stable angina or those with refractory angina pectoris. Expert Opin Pharmacother. 2012;13(17):2555–63.CrossRefPubMed
31.
Zurück zum Zitat Szwed H, Sadowski Z, Elikowski W, et al. Combination treatment in stable angina using trimetazadine and metoprolol. Eur Heart J. 2001;22:67–274. Szwed H, Sadowski Z, Elikowski W, et al. Combination treatment in stable angina using trimetazadine and metoprolol. Eur Heart J. 2001;22:67–274.
32.
Zurück zum Zitat Thadani U. Modified-release formulation of trimetazadine for exceptional control of angina pectoris: fact or fiction. Am J Cardiol. 2005;5(5):331–4. Thadani U. Modified-release formulation of trimetazadine for exceptional control of angina pectoris: fact or fiction. Am J Cardiol. 2005;5(5):331–4.
33.
Zurück zum Zitat Borer JS et al. Antianginal and antiischemic effects of ivabradine, an if inhibitor, in stable angina: a randomized, double blind, multicentered, placebo-controlled trial. Circulation. 2003;107:817–23.CrossRefPubMed Borer JS et al. Antianginal and antiischemic effects of ivabradine, an if inhibitor, in stable angina: a randomized, double blind, multicentered, placebo-controlled trial. Circulation. 2003;107:817–23.CrossRefPubMed
34.
Zurück zum Zitat Tardif J-C. Ford I, Bourassa M G, et al. efficacy of ivabradine, a new selective if inhibitor, compared with atenolol in patients with chronic stable angina. Eur Heart J. 2005;26:2529–36.CrossRefPubMed Tardif J-C. Ford I, Bourassa M G, et al. efficacy of ivabradine, a new selective if inhibitor, compared with atenolol in patients with chronic stable angina. Eur Heart J. 2005;26:2529–36.CrossRefPubMed
35.
Zurück zum Zitat Tardif J-C, Ponilkowski P, Kahan T, Investigators AS. Efficacy of the if current inhibitor ivabradine in patients with chronic stable angina receiving beta-blocker therapy: a 4 month randomized, placebo controlled trial. Eur Heart J. 2009;30:540–8. Tardif J-C, Ponilkowski P, Kahan T, Investigators AS. Efficacy of the if current inhibitor ivabradine in patients with chronic stable angina receiving beta-blocker therapy: a 4 month randomized, placebo controlled trial. Eur Heart J. 2009;30:540–8.
36.
Zurück zum Zitat Ruzylow TM, Ford I, Fox KM. Antianginal efficacy and safety of ivabradine compared to amlodipine in patients with stable angina pectoris. A 3 month randomized, double blind, multicenter, non-inferiority trial. Drugs. 2007;67:393–405. Ruzylow TM, Ford I, Fox KM. Antianginal efficacy and safety of ivabradine compared to amlodipine in patients with stable angina pectoris. A 3 month randomized, double blind, multicenter, non-inferiority trial. Drugs. 2007;67:393–405.
37.
Zurück zum Zitat Tardif JC, Ponikowiski P, Kahan T. Associate study investigators. Efficacy of the I9f) current inhibitor ivabradine in patients with chronic stable angina receiving beta-blockers therapy, a 4 month, randomized, placebo - controlled trial. Eur Heart J. 2009;30:540–8. Tardif JC, Ponikowiski P, Kahan T. Associate study investigators. Efficacy of the I9f) current inhibitor ivabradine in patients with chronic stable angina receiving beta-blockers therapy, a 4 month, randomized, placebo - controlled trial. Eur Heart J. 2009;30:540–8.
38.
Zurück zum Zitat Fox K, Ford I, Steg PG, Tenera M, Ferrari R, BEAUTIFUL Investigators. Ivabradine for patients with stable coronary artery disease and left ventricular dysfunction (BEAUTIFUL): a randomized, double blind, placebo controlled trial. Lancet. 2008;372:807–16.CrossRefPubMed Fox K, Ford I, Steg PG, Tenera M, Ferrari R, BEAUTIFUL Investigators. Ivabradine for patients with stable coronary artery disease and left ventricular dysfunction (BEAUTIFUL): a randomized, double blind, placebo controlled trial. Lancet. 2008;372:807–16.CrossRefPubMed
39.
Zurück zum Zitat Fox K, Ford I, Fleg P, Tardif JC, Tandera M, Ferrari R. Signify investigators. Ivabradine in stable coronary artery disease without clinical heart failure. N Engl J Med. 2014;371:1090–9.CrossRef Fox K, Ford I, Fleg P, Tardif JC, Tandera M, Ferrari R. Signify investigators. Ivabradine in stable coronary artery disease without clinical heart failure. N Engl J Med. 2014;371:1090–9.CrossRef
40.
Zurück zum Zitat Swedberg K, Komajda M, Boehm M, Borer JS, Ford I, Investigators SHIFT. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomized placebo-controlled study. Lancet. 2010;376:875–85.CrossRefPubMed Swedberg K, Komajda M, Boehm M, Borer JS, Ford I, Investigators SHIFT. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomized placebo-controlled study. Lancet. 2010;376:875–85.CrossRefPubMed
41.
Zurück zum Zitat Norman A, Ang DS, Ogston S, et al. Effect of high dose allopurinol on exercise in patients with chronic stable angina: a randomized, placebo controlled crossover trial. Lancet. 2010;375:2161–21167.CrossRef Norman A, Ang DS, Ogston S, et al. Effect of high dose allopurinol on exercise in patients with chronic stable angina: a randomized, placebo controlled crossover trial. Lancet. 2010;375:2161–21167.CrossRef
42.
Zurück zum Zitat MERIT-HF Study Group. Effect of Metoprolol CR/XL in Chronic Heart failure: metoprolol CR/XL randomized Intervention 1996; 335:217-225 Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999:353:2001–2007. MERIT-HF Study Group. Effect of Metoprolol CR/XL in Chronic Heart failure: metoprolol CR/XL randomized Intervention 1996; 335:217-225 Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999:353:2001–2007.
43.
Zurück zum Zitat CIBIS-II Investigators and Committees. The Cardiac Insufficiency Bisoprolol Stusy II (CIBIS II): a randomized trial. Lancet 1999;353:9–13. CIBIS-II Investigators and Committees. The Cardiac Insufficiency Bisoprolol Stusy II (CIBIS II): a randomized trial. Lancet 1999;353:9–13.
44.
Zurück zum Zitat Packer M, Coates AJ, Fowler MD, et al. Carvedilol prospective randomized cummulative survival study group. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med. 2001;344:1651–8.CrossRefPubMed Packer M, Coates AJ, Fowler MD, et al. Carvedilol prospective randomized cummulative survival study group. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med. 2001;344:1651–8.CrossRefPubMed
45.
Zurück zum Zitat Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary artery disease. N Engl J Med. 2007;356:1503C16. Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary artery disease. N Engl J Med. 2007;356:1503C16.
46.
Zurück zum Zitat The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Comparison of Coronary Bypass Surgery with Angioplasty in Patients with Multivessel Disease. N Eng J Med. 1996;335:217–25. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Comparison of Coronary Bypass Surgery with Angioplasty in Patients with Multivessel Disease. N Eng J Med. 1996;335:217–25.
47.
Zurück zum Zitat The BARI. 2D study group. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360:2503–015.CrossRef The BARI. 2D study group. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360:2503–015.CrossRef
48.
Zurück zum Zitat Dagenais GR, Lu J, Faxon DP, et al. BARI 2 study group. Effect of optimal medical treatment with or without coronary revascularization on angina and subsequent revascularization in patents with type 2 diabetes mellitus and stable ischemic heart disease. Circulation. 2011;123:1492–548.CrossRefPubMed Dagenais GR, Lu J, Faxon DP, et al. BARI 2 study group. Effect of optimal medical treatment with or without coronary revascularization on angina and subsequent revascularization in patents with type 2 diabetes mellitus and stable ischemic heart disease. Circulation. 2011;123:1492–548.CrossRefPubMed
49.
Zurück zum Zitat Stergiopolous K, Boden WE, Hartigan P, et al. Percutaneous coronary intervention outcomes in patients with stable obstructive coronary artery disease and myocardial ischemia: a collaborative met-analysis of contemporary randomized clinical trials. JAMA Intern Med. 2014;174:232–40.CrossRef Stergiopolous K, Boden WE, Hartigan P, et al. Percutaneous coronary intervention outcomes in patients with stable obstructive coronary artery disease and myocardial ischemia: a collaborative met-analysis of contemporary randomized clinical trials. JAMA Intern Med. 2014;174:232–40.CrossRef
51.
Zurück zum Zitat Critchley J., Capewell, S. Smoking cessation for secondary prevention of coronary heart disease Cochrane Database Syst Rev 2004(1):CD003041. Critchley J., Capewell, S. Smoking cessation for secondary prevention of coronary heart disease Cochrane Database Syst Rev 2004(1):CD003041.
52.
Zurück zum Zitat Fillon KB, El Khoury F, Bielinski M, et al. Omega-3fatty acids in high risk cardiovascular patients: a meta-analysis of randomized controlled trials. BMC Cardiovasc Disord. 2010;10:24. Fillon KB, El Khoury F, Bielinski M, et al. Omega-3fatty acids in high risk cardiovascular patients: a meta-analysis of randomized controlled trials. BMC Cardiovasc Disord. 2010;10:24.
53.
Zurück zum Zitat Estruch R, Ros E, Salas-Salvado J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279–90.CrossRefPubMed Estruch R, Ros E, Salas-Salvado J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279–90.CrossRefPubMed
54.
Zurück zum Zitat Henerson RA, O’Flynn N. Management of stable angina: summary of NICE guidelines. Heart. 2012;98:500–7.CrossRef Henerson RA, O’Flynn N. Management of stable angina: summary of NICE guidelines. Heart. 2012;98:500–7.CrossRef
55.
Zurück zum Zitat Juul-Moller S, Edvardsson N, Jahnmatz B, et al. Double blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina. The Swedish angina pectoris trial (SAPAT) group. Lancet. 1992;340:1421–5.CrossRefPubMed Juul-Moller S, Edvardsson N, Jahnmatz B, et al. Double blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina. The Swedish angina pectoris trial (SAPAT) group. Lancet. 1992;340:1421–5.CrossRefPubMed
56.
Zurück zum Zitat Scandinavian Simvastatin Survival Study group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian simvastatin survival study (4 s). Lancet. 1994;344:1383–9. Scandinavian Simvastatin Survival Study group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian simvastatin survival study (4 s). Lancet. 1994;344:1383–9.
57.
Zurück zum Zitat The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015;373:2103–2116. The SPRINT Research Group. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015;373:2103–2116.
58.
Zurück zum Zitat The Accord Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010;362:1575–1585 The Accord Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010;362:1575–1585
59.
Zurück zum Zitat De Bruvne B, Piils NHI, Kalesean B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012;367:991–1001.CrossRef De Bruvne B, Piils NHI, Kalesean B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012;367:991–1001.CrossRef
Metadaten
Titel
Management of Stable Angina – Current Guidelines: A Critical Appraisal
verfasst von
Udho Thadani
Publikationsdatum
16.09.2016
Verlag
Springer US
Erschienen in
Cardiovascular Drugs and Therapy / Ausgabe 4/2016
Print ISSN: 0920-3206
Elektronische ISSN: 1573-7241
DOI
https://doi.org/10.1007/s10557-016-6681-2

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