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Angina treatment: Stents, drugs, lifestyle changes — What's best?

So which angina treatment is better — angioplasty and stenting or medications?

In a 2007 study called the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial, researchers found that in people with chronic stable angina, getting a stent didn't improve their chances of preventing a heart attack or dying. In other words, getting an angioplasty and stent combined with taking medications and making lifestyle changes didn't prevent any additional deaths or heart attacks compared with only taking medications and making lifestyle changes.

Talk to your doctor about which angina treatment is right for you. Consider this:

  • People who have angioplasty and stenting first may have earlier and better symptom relief, such as reduced chest pain, than do people who just take medication. However, after five years, research has shown the chest pain relief was about the same between those who have angioplasty and stenting and those who only take medication.
  • People who take only medications to relieve their angina may not have quick chest pain relief, but medications require no recovery time and are much less expensive than are angioplasty and stenting. If you choose to take medications to treat your angina, it's important that you take them exactly as your doctor instructs you so that you get the maximum benefit from your medications.

What if your angina treatment doesn't work?

If you try medication and lifestyle changes first, but they don't relieve your angina, angioplasty and stents may be another option. It might be reasonable to try more-conservative steps first — medication and lifestyle therapy — before considering a stent. Talk to your doctor if you're concerned that medications or stents aren't controlling your angina. Remember that with either treatment plan, lifestyle changes are important to improving your symptoms and overall health.

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References
  1. Boden WE, et al. Optimal medical therapy with or without PCI for stable coronary disease. New England Journal of Medicine. 2007;356(15)1503-1516.
  2. Peterson ED, et al. Finding the courage to reconsider medical therapy for stable angina. New England Journal of Medicine. 2007;359(7):751-753.
  3. Shaw LJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden. Circulation. 2008;117(10):1283-1291.
  4. Weintraub WS. Effect of PCI on quality of life in patients with stable coronary disease. New England Journal of Medicine. 2008;359(7):677-687.
  5. Angina pectoris treatments. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4496 Accessed Sept. 25, 2008.

HB00091

Nov. 7, 2008

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