Defining Optimal Medical Therapy for Patients with Stable Angina.

Defining Optimal Medical Therapy for Patients with Stable Angina.

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A doctor listens to a patient's heart during an office visit. Both people are wearing masks.

Investigators advocate that lifestyle changes and medicine over surgery is appropriate for most patients in The Lancet

Coronary artery disease is a condition where the major blood vessels supplying the heart narrow, causing reduced blood flow, chest pain, and shortness of breath as well as heart attacks and death. With more than 3 million new cases in the U.S. annually, coronary artery disease is quite common and treatable with lifestyle changes and medication, which can prevent heart attacks and death. Sometimes, surgery or a procedure to insert a stent in the coronary arteries are also necessary. However, recent studies have shown that such procedures are needed in fewer cases.

In a recent publication in The Lancet, MedStar Health investigator Dr. William Weintraub, Director of Population Health Research for MedStar Health Research Institute, and collaborators advocate that a more conservative approach to treatment, or one that prioritizes medical management over surgery over the course of several months, may, in fact, be the more clinically appropriate, cost-effective, and evidence-based option for most patients.

While working with a patient with coronary artery disease, physicians will recommend treatment to achieve two main goals:

  1. Prevent future heart attacks and deaths by managing cholesterol and blood pressure
  2. Manage symptoms and quality of life.

There have been numerous studies that show how a healthy diet and exercise combined with medications can prevent cardiovascular events like heart attacks or stroke, but there are fewer conclusions on how medication can manage symptoms, like chest pain.

For symptom control, Weintraub and collaborators propose the following steps before considering surgical options:

  • Non-invasive testing with CT coronary angiography and potentially supplementary echocardiography.
  • Non-invasive testing with CT coronary angiography and potentially supplementary echocardiography.
  • Other therapeutics to target the underlying mechanical cause, as necessary.
  • Periodic (ideally monthly) assessments with the patient to evaluate how the medicine is working.

In addition to careful diagnostic testing and medicine, the article also recommends a patient-centered approach to managing lifestyle factors like diet and exercise. Primary care providers and specialists should collaborate with the patient to recommend specific changes in their daily life and continue monitoring impact over the course of six to twelve months.

As investigators, clinicians, and scientists continue to explore how to ease the burden of heart disease, this article argues that considering conservative, less invasive, and less risky treatments is a worthwhile investment for both patients and providers. For providers, the evidence on health outcomes is clear. For patients, this means a focus on day-to-day wellbeing and medicine without a potentially costly, emotionally, and physically taxing, and even risky visit to the operating room. MedStar Health is proud to continue work like this to provide patients with the best care for them while offering insights to better the medical community and beyond.

Collaborating authors on this publication include investigators from VA Boston Healthcare System, University of London, and Imperial College London.

The Lancet, DOI: 10.1016/S0140-6736(21)02045-6

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