IMPACT OF LIFE STYLE MODIFICATIONS, ANTIANGINALS, ANTIPLATELETS AND LIPID MODIFYING DRUGS AND OF CORONARY ARTERY REVASCULARIZATION ON MORTALITY AND MORBIDITY IN PATIENTS WITH ISCHEMIC HEART DISEASE: TRUTH AND FALSE NOTIONS
Udho Thadani, M.D., University of Oklahoma HSC and VA Medical Center, Oklahoma City, OK, USA
Stable ischemic heart disease (SIHD) is a new term in vogue; and one must address not only the impact of treatment on symptoms and quality of life but also on mortality and other serious adverse cardiovascular outcomes (SACO) such as myocardial infarction (MI) and stroke. Lifestyle alterations (abstinence of smoking, regular exercise and lipid modifying treatment with statins, reduce the incidence of SACO. But modifying abnormal lipids with niacin, or fibrates or raising HDL cholesterol with CTEP blockers, do not decrease SACO. Daily aspirin use in patients with SIHD and adequate control of blood pressure also reduce SACO. Antianginal agents reduce angina frequency and increase exercise tolerance but have little impact on mortality with only few exceptions, such as the use of beta blockers and ACE inhibitors after an acute MI and in patients with reduced left ventricular systolic function. Compared to optimal medical treatment, coronary revascularization, even in patients with diabetes and SIHD, does not reduce mortality or rates of MI but does relieve patient symptoms more effectively at least for the short term. Older medications such as allopurinol and colchicine have shown benefit in recent trials, but large outcome trials are needed before recommending their routine use. Individualization of treatment which takes into consideration patientsí lifestyle and presence of comorbidities which impact outcomes, and influence selection of treatment strategy, is critical in providing the best available treatment to patients with SIHD.