Stable ischemic heart disease: how to keep it that way

ARTICLE: Stable ischemic heart disease: how to keep it that way

AUTHORS: Thorsten M. LeuckerSteven P. Schulman and Gary Gerstenblith

JOURNAL: J Clin Invest. 2020 Jan 27. pii: 135959. doi: 10.1172/JCI135959. [Epub ahead of print]


The vast majority of the over 18 million Americans with known coronary atherosclerosis have stable disease (i.e., they do not have nor have they recently had an acute infarction or unstable angina) (1). Two management goals in this stable group have remained the same for over 50 years: to decrease angina symptoms if any are present and to decrease the likelihood of a subsequent myocardial infarction or cardiac death. Regarding the first goal, it is fairly easy to identify those experiencing symptoms and assess the relative benefits of interventions. The second goal, to identify those at increased risk for transitioning to unstable disease and to favorably alter that risk, is more uncertain. Our understanding of the pathophysiology and the implications of that understanding, in terms of management, have shifted over the years — a change that was accelerated by the results of the ISCHEMIA trial presented by Dr. Judith Hochman at the American Heart Association Scientific Sessions in November 2019 (2).

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