So what is Optimal Medical Therapy for Stable Angina?

The results of the COUIRAGE study, which we summarized very briefly on April 1 (no joke, though!), made it clear that coronary catheterization with placing of a stent was no better than ‘optical medical therapy’ in terms of heart attack or death in the next 5 years or so. Potential patients are now probably asking “what optimal therapy was actually used”? Here is what was given:

· All patients received antiplatelet therapy with aspirin at a dose of 81 to 325 mg daily or 75 mg of clopidogrel daily, if aspirin they were intolerant to aspirin.

· long-acting metoprolol (a beta-blocking drug), amlodipine (a calcium channel blocker), and isosorbide mononitrate (a small artery dilating drug), alone or in combination.

· Lisinopril (an ACE-inhibitor) or losartan (an ARB or angiotensin receptor blocker).

· Aggressive reducing the absorption of cholesterol low-density lipoprotein (LDL) cholesterol levels to a target level of 60 to 85 mg/dL, using simvastatin (a statin) alone or in combination with ezetimibe (reduces the absorption of cholesterol). When the LDL cholesterol target is achieved, an attempt was made to raise the high-density lipoprotein (HDL) cholesterol to above 40 mg/dL and lower triglyceride to below 150 mg/dL, with exercise, extended-release niacin (vitamin B3) , or fibrates, alone or combined.

I know it seems a lot, but it’s much cheaper than stent surgery, and just as effective, apparently.