Madigan Army Medical Center, Joint Base Lewis-McCord, WA, USA.
Womack Army Medical Center, Fort Bragg, NC, USA.
Am Fam Physician. 2018 Mar 15;97(6):376-384.
Stable coronary artery disease refers to a reversible supply/demand mismatch related to ischemia, a history of myocardial infarction, or the presence of plaque documented by catheterization or computed tomography angiography. Patients are considered stable if they are asymptomatic or their symptoms are controlled by medications or revascularization. Treatment involves risk factor management, antiplatelet therapy, and antianginal medications. Tobacco cessation, exercise, and weight loss are the most important lifestyle modifications. Treatment of comorbidities such as diabetes mellitus, hyperlipidemia, and hypertension should be optimized to reduce cardiovascular risk. All patients should be started on a statin unless contraindicated. No data support the routine use of monotherapy with nonstatin drugs such as bile acid sequestrants, niacin, ezetimibe, or fibrates. Studies of niacin and fibrates as adjunctive therapy found no improvement in patient outcomes. Aspirin is the mainstay of antiplatelet therapy; clopidogrel is an alternative. Antianginal medications should be added in a stepwise approach beginning with a beta blocker. Calcium channel blockers, nitrates, and ranolazine are used as adjunctive or second-line therapy when beta blockers are ineffective or contraindicated. Select patients may benefit from coronary revascularization with percutaneous coronary intervention or coronary artery bypass grafting.
稳定性冠状动脉疾病是指与缺血、心肌梗死病史或通过导管或计算机断层血管造影术记录的斑块相关的可逆转的供需不匹配。如果患者无症状或其症状通过药物或血运重建治疗得到控制，则被认为是稳定的。治疗包括危险因素管理、抗血小板治疗和抗心绞痛药物治疗。戒烟、运动和减肥是最重要的生活方式改变。应优化治疗糖尿病、血脂异常和高血压等合并症，以降低心血管风险。除非有禁忌证，否则所有患者均应开始使用他汀类药物。没有数据支持常规使用非他汀类药物（如胆汁酸螯合剂、烟酸、依折麦布或贝特类药物）进行单药治疗。烟酸和贝特类药物作为辅助治疗的研究并未发现患者结局改善。阿司匹林是抗血小板治疗的主要药物；氯吡格雷是一种替代药物。应逐步添加抗心绞痛药物治疗，从β受体阻滞剂开始。当β受体阻滞剂无效或禁忌时，钙通道阻滞剂、硝酸盐和雷诺嗪可用作辅助或二线治疗。某些患者可能受益于经皮冠状动脉介入治疗或冠状动脉旁路移植术进行冠状动脉血运重建。
