Summary of main recommendations regarding pharmacological management in patients with stable angina/stable coronary artery disease from NICE and the ESC
| NICE | ESC | |
|---|---|---|
| Optimal medical therapy | Consists of one or two antianginal drugs as necessary, plus drugs for secondary prevention of cardiovascular disease | Indicates at least one drug for angina/ischaemia relief, plus drugs for event prevention. (I C) |
| Immediate symptom relief | Short-acting nitrate | Short-acting nitrate. (I B) |
| Angina prophylaxis: | ||
| First line | β-Blocker and/or calcium channel blocker | β-Blocker and/or calcium channel blocker. (I A) |
| Second-line add-on therapy or alternative therapy when first-line agent contraindicated or not tolerated | Long-acting nitrate or ivabradine or nicorandil or ranolazine | Long-acting nitrate or ivabradine or nicorandil or ranolazine. (IIa B) |
| Trimetazidine may be considered. (IIb B) | ||
| Asymptomatic patients with large areas of ischaemia (>10% myocardium) | β-Blockers should be considered. (IIa C) | |
| Event prevention | Aspirin 75 mg | Low-dose aspirin. (I A) |
| Clopidogrel in cases of aspirin intolerance. (I B) | ||
| Statin in line with NICE clinical guideline on lipid modification*. Atorvastatin 80 mg to lower non-HDL-cholesterol by >40% | Statin. (I A) Treatment target for LDL-cholesterol <1.8 mmol/L and/or >50% reduction | |
| ACE inhibitor for patients with diabetes | ACE inhibitor (or ARB) if presence of other conditions (heart failure, hypertension, diabetes). (I A) |
*This was NICE clinical guideline 67 when the NICE stable angina guideline was published. It recommended using Simvastatin 40 mg, increasing to Simvastatin 80 mg if blood concentrations of total cholesterol <4 mmol/L and LDL-cholesterol <2 mmol/L were not attained. An update to the lipid modification guidance, NICE clinical guideline 181, was published in July 2014 which recommended the use of Atorvastatin 80 mg with the aim of reducing the blood non-HDL cholesterol concentration by at least 40%.
ACE, angiotensin converting enzyme; ARB, angiotensin receptor blocker; ESC, European Society of Cardiology; HDL, high-density lipoprotein; LDL, low-density lipoprotein; NICE, National Institute for Health and Care Excellence.