Cardiovascular disease (CVD) is the single best predictor of mortality in patients with end-stage renal disease (ESRD), as it accounts for almost 50 percent of deaths [1-4]. Of the cardiovascular deaths, approximately 20 percent can be attributed to the consequences of coronary heart disease (CHD). Patients with varying degrees of chronic kidney disease (CKD), but not yet dialysis-dependent, also have a markedly increased risk of morbidity and mortality from CVD, including CHD. (See "Patient survival and maintenance dialysis" and "Chronic kidney disease and coronary heart disease".)
Most of the issues relating to CHD are similar in patients with and without renal failure. This topic review will emphasize those features of the treatment of CHD that distinguish the dialysis patient from those without kidney disease. Related issues, such as secondary prevention and diagnosis of CHD in dialysis patients, are presented separately. (See "Clinical manifestations and diagnosis of coronary heart disease in end-stage renal disease (dialysis)" and "Risk factors and epidemiology of coronary artery disease in end-stage renal disease (dialysis)" and "Secondary prevention of cardiovascular disease in end-stage renal disease (dialysis)".)
There are two types of angina resulting from coronary heart disease (CHD), stable and unstable:
- Stable angina refers to chest discomfort that occurs predictably and reproducibly at a certain level of exertion and is relieved with rest or nitroglycerin.
- Unstable angina is an acute coronary syndrome that encompasses a variety of clinical conditions, including the new onset of angina, rest angina, an accelerating pattern of previously stable angina, post-myocardial infarction (MI) angina, and angina after a revascularization procedure. (See "Classification of unstable angina and non-ST elevation myocardial infarction".)
PHARMACOLOGIC TREATMENT OF STABLE CORONARY HEART DISEASE
A clinical diagnosis of angina has an extremely high predictive accuracy for the presence of coronary artery disease. The management of stable angina involves pharmacologic intervention to prevent or minimize ischemia, reduction of risk factors for coronary heart disease (CHD), and revascularization in some patients. (See "Stable ischemic heart disease: Overview of care".)