Management of Chronic Angina

For those of you who've been diagnosed with so-called "chronic angina" or stable chest pain that it attributed to mild to moderate heart disease, medical management has become a preferred strategy. Accordingly, be sure that your treatments are optimal. The following points are taken from recently updated guidelines, include both medications and lifestyle techniques, and are to be used long term.

1. Know Your Blood Pressure:
Blood pressure control should target levels at least below <140/90 (<130/80 for patients with diabetes or chronic kidney disease) and preferentially less than 120/80 for all patients. Patients should be treated with the following blood pressure medications whenever possible: beta-blockers and ACE inhibitors, with the addition of other drugs like diuretics (such as HCTZ or chlorthalidone), if possible, and calcium blockers, if needed.

2. Take aspirin:
Aspirin should be taken daily at 81 mg (or 162 mg post CABG), preferably uncoated, unless there is a contraindication.

3. Exercise:
Daily physical activity is recommended for all patients. It should consist of 30 to 60 minutes of moderate-intensity aerobic activity like walking or swimming; additional resistance training 2 days per week is reasonable.

4.Know your Cholesterol Panel:
For LDL-cholesterol reduction, it is reasonable to aim for levels of <70 mg/dL and to use high-dose statin therapy, as we've discussed here on the Blog previously. Metamusil (pysllium) and plant sterol supplements are also helpful. For non-HDL (the total minus the good kind) and HDL (the good kind) optimization, niacin and fibrates (like Tricor) can be useful medication additions along with exercise, monosaturated oils (like olive oil), fish and fish oils, and nuts from trees (the edible kind - not the human kind).

5. Know your Ejection Fraction (EF):
This is tested via echocardiogram. In the absence of significant kidney dysfunction or high potassium, post-heart attack patients with an ejection fraction <40% and either diabetes or heart failure should receive an aldosterone inhibitor (like Aldactone) in addition to therapeutic doses of an ACE inhibitor and a beta-blocker.

6. Know your BMI:
It should be between 18.5 and 24.9 kg/m2

7. Know your Waist Size:
It should be less than 35 (women) or less than 40 (men).

8. Don't smoke. Period.

9. All patients with heart disease should receive an annual influenza vaccination.

10. Chelation therapy may cause low calcium levels and is not recommended for patients with heart disease.

Review these recommendations against your current medication list and lifestyle plan. If you're not taking these medications or achieving these lifestyle goals, ask your doctor why not.