13 Aug Most Heart Disease Patients May Not Have Angina
Posted at 05:35h in Author Interviews, Heart Disease
MedicalResearch.com Interview with:
Professeur Philippe Gabriel Steg
Département de Cardiologie
Hôpital Bichat, Assistance Publique – Hôpitaux de Paris
Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
Medical Research: What are the main findings of this study?
Prof. Philippe Steg:
- Due to increasing use of angiography and revascularization, as well as improved drug therapy, the prevalence of angina and ischemia has diminished.
- Most of the events (Cardiovascular death or Myocardial Infarction) occur in patients without angina or ischemia. This is very novel and important and stresses the importance of proper secondary prevention over “testing”. We cannot be reassured by having a negative test for angina and ischemia.
- Additionally, angina appears associated with a consistently greater risk than ischemia alone (having both is worse), so we need to pay attention to angina as a dire prognostic marker.
- Findings should be no different in the US.
- Most studies of silent ischemia antedate the advent of modern effective therapies or used very liberal definitions for “silent ischemia”. (see our discussion)
Medical Research: What should patients and providers take away from this report?
The clinical implications are:
- Implement rigorous secondary prevention in all Coronary Artery Disease patients even if they are asymptomatic and have a negative test for ischemia. While having a negative test is better than having angina or ischemia, we cannot be reassured by that sufficiently to “lower our guard”.
- Consider more aggressive management (and intervention) in patients with persistent angina as their prognosis is poor (but we cannot give as strong a recommendation about this because our study was observational).
Steg P, Greenlaw N, Tendera M, et al. Prevalence of Anginal Symptoms and Myocardial Ischemia and Their Effect on Clinical Outcomes in Outpatients With Stable Coronary Artery Disease: Data From the International Observational CLARIFY Registry. JAMA Intern Med. Published online August 11, 2014. doi:10.1001/jamainternmed.2014.3773.