Current options in the management of coronary artery disease.

World Health Organization projections suggest that, for the foreseeable future, coronary artery disease (CAD) will remain the largest element of global disease burden, reflecting the aging of the population. Recent American College of Cardiology/American Heart Association guidelines estimate that 16.6 million Americans currently have stable angina. Chronic stable angina is associated with significant morbidity and mortality, thus highlighting the need for accurate and early detection and treatment. Clinical examination is the single most important step in evaluating risk. Age, sex, pain type, coexisting diabetes mellitus, hypertension, or known vascular disease are powerful predictors of prognosis and, except for special patient groups, are more reliable than ambulatory electrocardiographic recording, exercise testing, or electron-beam computed tomography. Cost-effective methods for screening the general population for "silent" risk factors predisposing them to atherosclerotic disease in later life are nevertheless required. Aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and lipid-lowering agents are currently the backbone of pharmacologic therapy, supplemented by lifestyle changes aimed at promoting exercise, weight reduction, and increased fruit and vegetable intake. However, side effects of chronic drug treatment, especially for those taking multidrug regimens, may affect quality of life and are the principal reason for poor compliance. Coronary bypass surgery and angioplasty are frequently used interventional procedures for CAD, although they can be invasive and costly, and they often need to be repeated. Current options for the management of CAD have their limitations, thus confirming the appropriateness of continuing the search for improved therapies to reverse the disease process and reduce the global burden.