Chronic coronary disease

With aggressive lifestyle modification and guideline-directed medical therapy, patients can expect a reduction in anginal symptoms. With guideline-directed management, 58% of patients can expect to be free of angina within 1 year.[212]Boden WE, O'Rourke RA, Teo KK, et al; COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007 Apr 12;356(15):1503-16. https://www.nejm.org/doi/full/10.1056/NEJMoa070829 http://www.ncbi.nlm.nih.gov/pubmed/17387127?tool=bestpractice.com Observational studies suggest spontaneous resolution of angina is also common, although this is more true of mild angina.[234]Mesnier J, Ducrocq G, Danchin N, et al. International observational analysis of evolution and outcomes of chronic stable angina: the multinational CLARIFY study. Circulation. 2021 Aug 17;144(7):512-23. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.054567 http://www.ncbi.nlm.nih.gov/pubmed/34261331?tool=bestpractice.com

Ischaemic heart disease is a dynamic process. Even with aggressive medical management and lifestyle changes, some patients may experience recurrence or worsening of anginal symptoms due to progression of atherosclerotic disease. Upwards titration of anti-anginal medications may resolve these symptoms; however, some patients may require revascularisation to improve anginal symptoms and exercise tolerance.

The same risk factors that predispose to coronary disease increase the risk of non-coronary atherosclerotic diseases such as stroke and peripheral artery disease. Measures taken to treat CCD may also reduce these adverse outcomes.