Management of Coronary Artery Disease and Chronic Stable Angina

Yesenia Camero, PharmD, BCPS; Jinwi Ghogomu, PharmD, BCPS, CPh


US Pharmacist. 2017;42(2):27-31. 

In This Article

Abstract and Introduction


Coronary artery disease (CAD) is the most common type of heart disease and the leading cause of death worldwide. Angina pectoris, a clinical syndrome characterized by discomfort typically located in the chest, neck, or left arm, is one of several clinical manifestations of CAD. The gold standard for diagnosing and evaluating CAD is coronary angiography. The goals of treatment are to maximize quality of life and minimize the risk of death through the modification of risk factors such as diabetes, hypertension, and hyperlipidemia and the management of acute ischemic symptoms. Some frequently used pharmacotherapeutic options include beta-blockers, calcium channel blockers, nitrates, ACE inhibitors, statins, and antiplatelet agents


Coronary artery disease (CAD), also known as coronary heart disease, coronary artery atherosclerosis, or stable ischemic heart disease (SIHD), occurs when there is an inadequate blood supply to the myocardium. This is usually caused by atherosclerotic buildup in the coronary arteries. CAD is the leading cause of death worldwide.[1]

Angina pectoris, a clinical syndrome characterized by discomfort typically located in the chest, neck, or left arm, is one of several possible clinical manifestations of coronary heart disease.[2] Chronic stable angina pectoris is a common manifestation of CAD. An estimated 15.5 million American adults have chronic CAD, and more than seven million have angina. Angina is the initial manifestation in approximately one-half of all patients who present with CAD. The presence of chronic angina approximately doubles the risk of major cardiovascular events (CVEs).[1]

Chest pain that can be characterized as chronic stable angina typically is produced with physical exertion and is relieved by rest and/or nitroglycerin. In contrast, chest pain that occurs at rest usually is indicative of unstable disease such as acute coronary syndromes (ACS).[2] Many patients, however, describe angina not as frank pain but as tightness, pressure, or discomfort. Women and the elderly, in particular, may present with atypical symptoms such as nausea, vomiting, mid-epigastric discomfort, or sharp (atypical) chest pain. Anginal pain caused by cardiac ischemia typically lasts minutes. The location is usually substernal, and pain can radiate to the neck, jaw, epigastrium, or arms. Pain above the mandible, below the epigastrium, or localized to a small area over the left lateral chest wall is rarely angina. Angina is often precipitated by exertion or emotional stress and relieved by rest. Sublingual nitroglycerin usually relieves angina within 30 seconds to several minutes.[3]