Ischemic heart disease is the leading cause of death in the United States. The most common manifestation of this disease is chronic stable angina. Angina is characterized by discomfort in the chest, jaw, shoulder, back, or arm and is typically aggravated by exertion or emotional stress. It occurs when the heart muscle doesn't receive enough oxygen, either from narrowed arteries caused by cholesterol deposits or from hypertension or valvular disease. Stable angina has a predictable pattern for a prolonged time.
Unstable angina is characterized by symptoms that are new or increasing.
The guidelines do not address unstable angina. The role of the ACP-ASIM in these guidelines is a reflection of the large number of stable angina patients who are being treated by general internists. Given the ongoing explosion of knowledge about cardiovascular disease, physicians may not always be aware of all of the latest advances. For example, lipid-lowering therapy has now been shown to reduce deaths and heart attacks in patients with coronary artery disease. Physicians need to recognize that lipid-lowering therapy is now clearly proven to improve patient outcome.