title: Medical management of stable coronary artery disease.
abstract: All patients with stable coronary artery disease require medical therapy to prevent disease progression and recurrent cardiovascular events. Three classes of medication are essential to therapy: lipid-lowering, antihypertensive, and antiplatelet agents. Lipid-lowering therapy is necessary to decrease low-density lipoprotein cholesterol to a target level of less than 100 mg per dL, and physicians should consider a goal of less than 70 mg per dL for very high-risk patients. Statins have demonstrated clear benefits in morbidity and mortality in the secondary prevention of coronary artery disease; other medications that can be used in addition to statins to lower cholesterol include ezetimibe, fibrates, and nicotinic acid. Blood pressure therapy for patients with coronary artery disease should start with beta blockers and angiotensin-converting enzyme inhibitors. If these medications are not tolerated, calcium channel blockers or angiotensin receptor blockers are acceptable alternatives. Aspirin is the first-line antiplatelet agent except in patients who have recently had a myocardial infarction or undergone stent placement, in which case clopidogrel is recommended. Anginal symptoms of coronary artery disease can be treated with beta blockers, calcium channel blockers, nitrates, or any combination of these. Familiarity with these medications and with the evidence supporting their use is essential to reducing morbidity and mortality in patients with coronary artery disease.
authors.affiliation: Clinica Family Health Services, Denver, CO, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Pflieger
authors.forename: Bradford T
authors.initials: BT
authors.lastname: Winslow
authors.forename: Kyle
authors.initials: K
authors.lastname: Mills
authors.forename: Ira M
authors.initials: IM
authors.lastname: Dauber
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D062186:Arterial Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects; D002985:Clinical Protocols; D003324:Coronary Artery Disease / Q000378:metabolism / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D050356:Lipid Metabolism / Q000187:drug effects; D008077:Lipoproteins, LDL / Q000097:blood; D054539:Medication Therapy Management; D017063:Outcome Assessment, Health Care; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D040242:Risk Reduction Behavior; D055502:Secondary Prevention; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D000960:Hypolipidemic Agents; D008077:Lipoproteins, LDL; D010975:Platelet Aggregation Inhibitors