Angina, Chronic Stable

Incidence in USA: 3 million.

Annual rates per 1000 new episodes of angina for non-African American men are 28.3 for ages 65–74, 36.3 for ages 75–84, and 33.0 for age 85 and older. For non-African American women in the same age groups, the rates are 14.1, 20.0, and 22.9, respectively. For African American men, the rates are 22.4, 33.8, and 39.5, and for African American women, the rates are 15.3, 23.6, and 35.9, respectively.

African Americans have highest death rates, although overall death rates are decreasing over time.

Increased risk of periop MI and death varies, depending on study (3–12%).

Risk of LV dysfunction, myocardial ischemia, hypotension, and MI.

Increasing frequency of symptoms (i.e., unstable angina)

Signs of LV dysfunction with ischemia

Silent myocardial ischemia

Chronic stable angina identifies pts at risk for developing myocardial ischemia and MI.

Angina is present in <25% of episodes of myocardial ischemia.

Symptoms should be stable for previous 60 d for “stable” diagnosis.

Can result from

• Inadequacy of myocardial O ₂ supply in pts with critical coronary artery stenosis.

• Coronary vasospasm.

• Inadequacy of myocardial O ₂ supply secondary to increased demand from ventricular hypertrophy.

• Endothelial cell-mediated vasoconstriction.

Thrombosis overlying unstable plaque can lead to unstable angina/MI.

Acquired disease with genetic predisposition.

Pts with diabetes have higher incidence of CAD, which is frequently silent.

Other risk factors include Htn, hyperlipidemia, advanced age, tobacco use, and homocysteinemia.