Therapeutic options for patients with chronic myocardial ischaemia

Coronary heart disease (CHD) is a leading cause of death and disability worldwide. Chronic myocardial ischaemia resulting from CHD can cause stable angina and interfere with ordinary activities. Numerous approaches for reducing myocardial ischaemia are currently available. These include lifestyle changes such as weight reduction, exercise, smoking cessation and reduced consumption of salt and fat; pharmacological approaches such as use of anti-platelet agents, statins, angiotensin converting enzyme inhibitors, β-blockers, calcium channel blockers and nitrates; surgical revascularization approaches such as coronary artery bypass grafting and percutaneous methods (balloon angioplasty, bare-metal stents, drug eluting stents). Alternative methods for reducing anginal pain such as external enhanced counterpulsation and spinal cord stimulation are also available. Despite this wide range of choices, patients with ischaemic heart disease usually require a combination of these therapies, and may continue to experience symptoms. While traditional therapies continue to be improved, strategies to increase myocardial circulation by stimulating formation of collateral vessels around obstructed coronary arteries are also in development. These approaches include therapy with recombinant growth factor proteins, transfer of growth factor genes and stem cell therapy. It is hoped that at least one of these approaches will safely and effectively reduce myocardial ischaemia, providing a new option for patients with CHD.