Ischemic heart disease

A two-part, four-article symposium

Symposium coordinator

Amy C. Bales, MD
Assistant Professor of Clinical Medicine
Section of Cardiology
Chicago College of Osteopathic Medicine
Midwestern University

VOL 115 / NO 2 / FEBRUARY 2004 / POSTGRADUATE MEDICINE

INTRODUCTION TO THE SYMPOSIUM: Part 1 of a two-part, four-article symposium. By Amy C. Bales, MD
NONINVASIVE TESTS FOR CARDIAC RISK STRATIFICATION: Which ones are most prognostic? By Robert L. Litchfield, DO
MEDICAL MANAGEMENT OF CHRONIC ISCHEMIC HEART DISEASE: Selecting specific drug therapies, modifying risk factors. By Amy C. Bales, MD

Ischemic heart disease is a major concern in the United States, in terms of both its impact on the health of affected individuals and the economic burden it places on society as a whole. In the year 2000, the American Heart Association estimated that more than 12 million people in the United States had coronary artery disease (CAD). The economic cost of CAD approached $120 billion that year. As physicians, we have the duty to be as knowledgeable as possible about the assessment and treatment of CAD. This includes providing the most effective therapy possible to preserve life and decrease symptoms. It is also our responsibility to deliver this care in such a way that our precious health resources are allocated in the most beneficial manner.

The symposium begins with an article by Dr Robert L. Litchfield on the noninvasive risk stratification of patients with coronary atherosclerosis. Dr Litchfield focuses on the role of stress testing, the different modalities available, and their advantages and disadvantages. Other available imaging methods, such as ultrafast computed tomography and positron emission tomography, are also addressed.

In the second article of the symposium, I discuss medical treatment of patients with coronary atherosclerosis. Therapies shown to reduce morbidity and mortality from CAD are a primary focus, as are therapies used for symptom control in patients with chronic stable angina pectoris. The role of risk factor modification and its importance in these patients is also included in the discussion.

The symposium continues in the March issue of Postgraduate Medicine with an article by Dr A. Arif Khalil on catheter-based therapy for coronary atherosclerosis. Modalities currently available for percutaneous coronary interventions are discussed, including the latest tool in the physician's armamentarium, the drug-eluting stent. It is now possible for cardiologists to invasively treat a wide variety of difficult lesions, and Dr Khalil addresses the advantages and disadvantages of specific devices in certain patient subgroups. Adjunctive pharmacologic therapy used in this setting is described as well.

The final article of the symposium is presented by Dr C. Richard Smith, who focuses on strategies for lipid modification and control in the patient with chronic ischemic heart disease. Currently available treatment options are discussed, including new and novel agents, and specific patient populations are considered.

The treatment of patients with chronic ischemic heart disease is a challenging task and one that is frequently encountered in clinical practice. This symposium highlights current strategies for assessment and treatment of patients with this all-too-common affliction. By consistently applying these interventions, we physicians can continue to have a positive impact on public health by lowering the mortality rate and improving the overall well-being of patients with CAD.

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