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Controversies in Internal Medicine |

Rebuttal

David T. Nash, MD
Arch Intern Med. 2005;165(22):2592-2593. doi:10.1001/archinte.165.22.2592.
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Dr King argues that medical treatment should be divided into therapies that stabilize atherosclerosis and prevent cardiovascular events and those that reduce angina by decreasing oxygen demand or improving hemodynamics to increase oxygen supply. I couldn’t agree more with these cogent comments but maintain that aggressive medical therapy rather than invasive therapy with both of these goals in mind should be the first choice for patients with stable angina; such a regimen can achieve both goals. Such aggressive medical treatment should include (1) nitrates, β-blockers, and calcium channel blockers aimed at achieving a blood pressure of less than 130/80 mm Hg; (2) aggressive statin therapy aimed at achieving a LDL-C level between 70 (1.81) and 100 mg/dL (2.59 mmol/L); (3) discontinuation of smoking; (4) an active exercise program; and (5) a diet rich in vegetables, fruit, fiber, fish, and n-3 polyunsaturated fatty acids. If a patient is overweight, a weight reduction program aimed at a body mass index (weight in kilograms divided by the square of height in meters) of less than 25 should be recommended and the patient encouraged to see a dietitian and an exercise consultant if possible.

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