Table 4

Summary of main recommendations regarding pharmacological management in patients with stable angina/stable coronary artery disease from NICE and the ESC

Optimal medical therapyConsists of one or two antianginal drugs as necessary, plus drugs for secondary prevention of cardiovascular diseaseIndicates at least one drug for angina/ischaemia relief, plus drugs for event prevention. (I C)
Immediate symptom reliefShort-acting nitrateShort-acting nitrate. (I B)
Angina prophylaxis:
First lineβ-Blocker and/or calcium channel blockerβ-Blocker and/or calcium channel blocker. (I A)
Second-line add-on therapy or alternative therapy when first-line agent contraindicated or not toleratedLong-acting nitrate or ivabradine or nicorandil or ranolazineLong-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 preventionAspirin 75 mgLow-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 diabetesACE 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.