Management of Angina

Pharmacological Interventions

The European Society of Cardiology recommends that all patients with angina should immediately receive aspirin 75-100 mg daily and sublingual nitroglycerin for acute symptom relief, combined with aggressive risk factor modification including mandatory smoking cessation, lipid management with statins, blood pressure control, and initiation of beta-blockers or calcium channel blockers for symptom control 1, 2
Aspirin 75-100 mg daily is mandatory for all patients with angina to reduce cardiovascular mortality and morbidity, as recommended by the European Society of Cardiology 1, 2
Clopidogrel 75 mg daily is an acceptable alternative if aspirin is contraindicated, according to the European Society of Cardiology 2
Beta-blockers and/or calcium channel blockers (CCBs) are recommended as initial regular therapy for most patients, as suggested by the European Society of Cardiology 1, 2
The choice between beta-blockers and CCBs should be guided by comorbidities, with beta-blockers preferred in patients with prior myocardial infarction, heart failure, or supraventricular arrhythmias, and CCBs preferred when beta-blockers are contraindicated 1, 2

Smoking cessation must be strongly emphasized as it directly impacts mortality, as recommended by the European Society of Cardiology 9, 3, 5
All patients require serum cholesterol measurement, and statin therapy should be initiated to achieve LDL-C <70 mg/dL when possible, according to the American College of Cardiology 4, 5, 8
Blood pressure should be measured and managed according to hypertension guidelines, with particular importance as hypertension accelerates atherosclerotic progression, as suggested by the European Society of Cardiology 4, 5, 3

Aerobic physical activity of 150-300 minutes per week at moderate intensity or 75-150 minutes at vigorous intensity is recommended, as suggested by the European Society of Cardiology 1, 2
A Mediterranean diet with emphasis on vegetables, fruit, fish, and poultry is recommended, according to the European Society of Cardiology 9, 3
Fish consumption at least once weekly is recommended, as suggested by the European Society of Cardiology 9
Alcohol in moderation may be beneficial, but excessive consumption is harmful, according to the European Society of Cardiology 9, 3

Patients must understand the nature of angina and when to seek emergency care, including alarm symptoms requiring immediate medical attention, as recommended by the European Society of Cardiology 9, 3
Patients should rest briefly from activities that provoke angina, as suggested by the European Society of Cardiology 9, 3