Medical Management of Chronic Coronary Disease

Chronic coronary disease, previously known as stable ischemic heart disease, is a spectrum of coronary artery disease characterized by obstructive or nonobstructive atherosclerotic plaque accumulation in the coronary arteries. Functional noninvasive tests used to diagnose obstructive coronary artery disease can detect myocardial ischemia through electrocardiographic changes, wall motion abnormalities, or cardiac perfusion changes. These tests include stress echocardiography, stress cardiac magnetic resonance imaging, or stress single-photon emission computed tomography. The goals when treating chronic coronary disease are to improve patients’ quality of life and extend their lifespan. Management includes lifestyle and risk factor optimization through diet and exercise; control of hyperlipidemia, blood pressure, and diabetes; long-term beta-blocker therapy; antianginal treatment; and antiplatelet therapy. Treatments should aim to reduce cardiac death, nonfatal ischemic events, and progression of atherosclerosis, using guideline-directed medical therapy. Clinicians should assess the socioeconomic status of patients who have chronic coronary disease and provide resources to community-based health workers when available.