Nonsurgical Management of Chronic Exertional Angina in Older Adults

Kenneth R. Melvin, MD, FRCPC, Associate Professor, Department of Medicine, Cardiology, University Health Network, University of Toronto, Toronto, ON.
Lindsay J. Melvin, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON.

The increasing average age of natural survival and effective therapies for many previously fatal illnesses have increased the older adult population. Thus, there is a concomitant increase in long-term treatment requirements for many conditions, including chronic angina pectoris. Advances in nonsurgical interventions include angioplasty and stent technology. The medical treatment of angina should be individualized to the patient and usually involves multiple-drug regimens. Mainstays of therapy include acetylsalicylic acid and nitroglycerin 0.4 mg spray with combinations of long-acting nitrates, beta-blockers, calcium channel blockers, and the ancillary use of angiotensin-converting enzyme inhibitors and statins. Risk reduction involves controlling modifiable factors, including smoking, weight control, hypertension, and hyperlipidemia; this will reduce disease progression and cardiac event occurrences. Older adults should be monitored for drug interactions and sensitivity to medication in the presence of associated medical problems and other therapies. Cardiac rehabilitation programs are a useful addition to comprehensive medical treatments for chronic stable angina.
Key words: angina, antianginal drug therapy, risk reduction, cardiac rehabilitation, percutaneous coronary intervention, PCI.