OPTIMAL MEDICAL THERAPY: FOR SYMPTOMS CONTROL

Abstract

One of the main objectives in the treatment of chronic coronary artery disease is to improve quality of life, by controlling the symptoms of angina, which are often limiting. To perform this task, the physician must offer the patient what we call optimal medical therapy, which includes education on lifestyle modifications, control of risk factors and comorbidities, pharmacological treatment and, in selected cases, myocardial revascu-larization. The initial drug therapy usually consists of one or two classes of antianginal drugs plus secondary prevention medications. A significant proportion of patients do not satisfactorily achieve the goal of controlling the symptoms of angina, many of which for not receiving a truly optimal medical therapy, with maximum tolerated doses of antianginal drugs, in combination therapy, according to the individual characteristics of each patient. There is strong evidence indicating that all classes of antianginals have similar efficacy in the treatment of angina and myocardial ischemia and, nevertheless, none of them reduce cardiovascular events, except for beta-blockers in patients with left ventricular dysfunction or recent myocardial infarction. There is no definition of which drug or combination is optimal, and there is no evidence to support the use of the terms “first- and second-line” drugs in the treatment of angina. We suggest, therefore, that the best strategy should be individualized, choosing the antianginal drug according to the patients’ clinical charac-teristics and comorbidities.