Senior Health Medications for Stable Angina 12/26/2023 | By Howard LeWine, M.D. Accepted treatment for angina has changed over the last few decades. Dr. Howard LeWine of Harvard Medical discusses optimal treatment and explains the difference between unstable and stable angina – and when to be concerned. Question: I get chest heaviness if I walk too fast or get excited. It goes away quickly when I stop or calm down. I think I have angina. Will I need to have a stent or surgery? Answer: Your symptoms suggest that you have stable angina. But you definitely need to call your doctor to arrange a thorough medical evaluation of your symptoms. If your doctor confirms it is angina, most likely it is due to coronary artery disease. Angina happens when the network of arteries that nourish the heart are narrowed by fatty and calcified plaque, a condition called atherosclerosis. The classic symptom — chest discomfort during physical exertion — is known as stable angina because it occurs in a predictable pattern. For decades, cardiologists debated the best way to treat this problem: a procedure to reopen the artery (angioplasty and a stent) or optimal medical therapy. Optimal medical therapy means taking medications you need to get your cholesterol, blood pressure, and blood sugar levels — the factors that underlie atherosclerosis risk — into a healthy range. The rationale for doing angioplasty on people with stable angina came from a long-held assumption that turned out to be wrong. Until about 30 years ago, the collective opinion was that atherosclerosis was an inexorable, progressive disease that would eventually block off one or more of the heart’s arteries, causing a heart attack. Doctors now recognize that most heart attacks occur in arteries that are only about 30% to 40% blocked but harbor so-called vulnerable plaque that ruptures without warning. The resulting blood clot blocks blood flow, triggering a heart attack. The impulse to open a severely narrowed artery with angioplasty and a stent is understandable. But several major trials confirm that for people with stable angina, stents don’t offer any advantage over optimal medical therapy when it comes to preventing heart attacks or death. Medications help treat (and perhaps stabilize and even reverse) atherosclerosis in all the heart’s arteries, whereas stents address only specific spots. Drug therapy is also less expensive and has fewer serious side effects. Understandably, people with stable angina worry about having a fatal heart attack. But studies show that the risk is low — only about 0.4% per year in people who are careful to address all their risk factors. That means not smoking, eating a healthy diet with plenty of plant-based foods, getting regular exercise, and managing stress, in addition to taking the right combination and doses of medicines. In contrast to stable angina, unstable angina tends to occur without warning, with only slight exertion or even when you’re resting or sleeping. Angina that becomes more frequent, worsens, or lasts longer than usual is considered unstable and may signal a heart attack. If your chest discomfort or other symptoms don’t get better within 10 minutes, call 911. Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu. ©2023 Harvard University. For terms of use, please see https://www.health.harvard.edu/terms-of-use. Distributed by Tribune Content Agency, LLC. See similar health articles like this one on Seniors Guide: Caring for Older Adults with Heart Issues Read More Howard LeWine, M.D. Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.