Stable angina is a chronic form of ischemic heart disease which occurs due to obstruction of the coronary arteries by atheromatous plaque and transient myocardial ischemia. The disease interferes with everyday activities of the person and may gradually lead to unstable angina and myocardial infarction – potentially life-threatening conditions. Various factors are associated with the increased risk of developing coronary artery disease and are related to the progression of the disease including non-modifiable and modifiable risk factors. As the modifiable risk factors may be controlled it is recommended to take measures in order to prevent the episodes of angina pain, development of coronary artery disease complications and reduce the risk of death by influencing these factors in the course of stable angina treatment.
Modifiable factors for stable angina include:
- Overweight and obesity;
- High blood cholesterol and triglycerides (hyperlipidemia);
- High blood pressure;
- Diabetes mellitus type 2 and glucose intolerance;
- Sedentary lifestyle, lack of physical activity;
- Overeating and unhealthy diet;
- Smoking cessation – Smoking is a well-known risk factor for a number of diseases. Smoking increases oxygen demand, causes coronary vasospasm, and decreases the effectiveness of the drugs used. Therefore, it is recommended to quit smoking for individuals with coronary artery disease.
- Exercising and physical activities –It is recommended to do aerobic exercises for at least 30 minutes 5 days a week.
- Maintaining a healthy body weight – Overweight and obesity are associated with an increased risk of cardiovascular diseases. A body – mass index (BMI) is calculated to estimate the person’s weight in relation to the height. The weight is considered normal if the BMI score is from 18.5 to 25 kg/m2, a person is considered overweight if the BMI score ranges from 25 to 30 kg/m2 and obese if the BMI score is over 30 kg/m2.
- Limited alcohol consumption – Alcohol consumption should be limited to no more than 1 drink per day.
- Manage stress – It is extremely important to avoid stressful situations and emotional exertion. If needed antidepressants should be taken.
- Control arterial pressure – For those who suffer from coronary artery disease the recommended arterial pressure is under 130/85 mmHg. Antihypertensive drugs may be prescribed to maintain blood pressure in healthy ranges.
Salty and spicy foods should be avoided as well as products that contain high levels of sodium (salt). A daily diet should include a variety of fruits, vegetables, whole grains, and seafood. The so-called Mediterranean diet is considered the healthiest.
Diet low in dietary cholesterol, saturated and trans fats is recommended to manage hyperlipidemia as one of the modifiable risk factors. Hyperlipidemia is a condition characterized by high levels of cholesterol and low-density lipoproteins (LDL) which are involved in atherogenesis and associated with a high risk of coronary artery disease. The cholesterol intake should not exceed 300 mg/day. On the other hand, unsaturated fats are essential for health and have protective properties against atherosclerosis as they are the source for high-density lipoproteins (HDL).
- Aspirin (at a dose of 75-325 mg once a day) significantly reduces the risk of myocardial infarction and prevents the progression of angina;
- Nitrates (nitroglycerin, isosorbide dinitrate, isosorbide mononitrate) effectively relieve the pain and abort the episode of angina providing smooth-muscle relaxation, peripheral and coronary artery dilatation mediated by nitric oxide and cyclic guanosine monophosphate. Oxygen supply is improved whilst oxygen demand decreases;
- Beta-blockers (metoprolol, bisoprolol, propranolol) have antiischemic properties due to their ability to reduce oxygen demand by reducing the heart muscle contractions;
- Calcium-channel blockers (verapamil, nifedipine, amlodipine) cause vasodilatation and improve the blood supply to the myocardium and at the meantime decrease the oxygen consumption;
- Statins (rosuvastatin, atorvastatin) help to control the total cholesterol and low-density cholesterol, which are involved in atherogenesis (formation of the atheromatous plaques). Long-term intake of statins reduces the risk of future cardiovascular events and prevents myocardial infarction.
Management of angina attack
When an episode of angina pain occurs the following measures should be taken:
- Stop whatever you’ve been doing, lie down if it’s possible. Relax, calm down and have a rest.
- If nitroglycerin was prescribed, take it under the tongue;
- If the symptoms do not vanish in a few minutes or become more severe, call the ambulance;