Update on the medical treatment of stable angina

Stable angina is a form of coronary artery disease. Its potential to progress requires the most appropriate treatment in order to reduce the incapacitating effect of an acute angina attack and to avoid long-term cardiovascular events. With or without revascularization, pharmacological treatment is an essential component of this treatment strategy, which also involves lifestyle and diet. Statins and aspirin have been shown to be effective in preventing different aspects of coronary artery disease overall. The efficacy of other classes of treatment has been demonstrated in contexts such as stable angina (including postmyocardial infarction) and heart failure (under specific conditions of dosing) for beta-blockers and in contexts such as heart failure, postinfarction and following revascularization for angiotensin-converting enzyme inhibitors. Along with the oldest classes of treatment, such as nitrates (and related derivatives), beta-blockers and calcium channel blockers, new classes of treatments with entirely (trimetazidine, ivabradine) or partly (nicorandil) different mechanisms of action have now been added. The latest antianginal to obtain marketing authorization, ranolazine, is not yet available in France. The different levels of evidence of the efficacy of these pharmacological products vary greatly and overall are higher for those developed most recently. None is devoid of side effects, which must be taken into account in these patients, many of whom are elderly and polymedicated.