Kenneth R. Melvin, MD, FRCPC, Associate Professor, Department of Medicine, Cardiology, University Health Network, University of Toronto, Toronto, ON.
Lindsay J. Melvin, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON.

The increasing average age of natural survival and effective therapies for many previously fatal illnesses have increased the older adult population. Thus, there is a concomitant increase in long-term treatment requirements for many conditions, including chronic angina pectoris. Advances in nonsurgical interventions include angioplasty and stent technology. The medical treatment of angina should be individualized to the patient and usually involves multiple-drug regimens. Mainstays of therapy include acetylsalicylic acid and nitroglycerin 0.4 mg spray with combinations of long-acting nitrates, beta-blockers, calcium channel blockers, and the ancillary use of angiotensin-converting enzyme inhibitors and statins. Risk reduction involves controlling modifiable factors, including smoking, weight control, hypertension, and hyperlipidemia; this will reduce disease progression and cardiac event occurrences. Older adults should be monitored for drug interactions and sensitivity to medication in the presence of associated medical problems and other therapies. Cardiac rehabilitation programs are a useful addition to comprehensive medical treatments for chronic stable angina.
Key words: angina, antianginal drug therapy, risk reduction, cardiac rehabilitation, percutaneous coronary intervention, PCI.

Sameer Satija, MD, Clinical Fellow, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
Nanette K. Wenger, MD, Professor of Medicine (Cardiology), Emory University School of Medicine, Atlanta; Chief of Cardiology, Grady Memorial Hospital, Atlanta, GA, USA.

Chronic angina is a common problem among older adults. The burden of coronary heart disease in patients over age 75 is high. Coronary angiography, percutaneous coronary intervention with or without stenting, and coronary artery bypass graft surgery all entail higher risk in the older population. Nevertheless, patients older than 75 also may accrue a greater benefit, given their increased risk for overall cardiac mortality. We suggest a measured approach to revascularization in older adults with chronic angina, considering their severity of symptoms, the adequacy of treatment of angina, their left ventricular ejection fraction, patient preference, other comorbidities, and ischemic burden identified by noninvasive testing.
Key words: angina, revascularization, older adults, coronary disease, coronary angiography.