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 angina-free within 1 year.[219]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.[249]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

Ischemic 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. Upward titration of antianginal medications may resolve these symptoms; however, some patients may require revascularization to improve anginal symptoms and exercise tolerance.

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