Cardiovascular diseases in general and chronic
myocardial ischemia in particular represent major public
health concerns that continue to have a poor prognosis.
Stunning advances of past decades in identification and
quantification of obstructive coronary artery disease
(CAD) stenosis represent the success of the traditional
belief that this condition underlies essentially all stable
ischemic heart disease (IHD) syndromes. The real
question is whether we can improve a patient’s quality of
life with the minimum risk. It follows that, once a patient
at high prognostic risk has been identified (usually by
exercise testing and subsequent angiography); we have
time to optimize the management of those at lower risk.
Thus time should be taken to address lifestyle issues and
utilize drug therapy based on the evidences. Over the
last 30 years considerable progress has been made in the
treatment of ischemic heart disease (IHD). However,
population studies confirm that the problem is far from
being solved, and IHD remains the leading cause of
morbidity and mortality. Compared with the past, today’s
patients tend to be older, to have undergone
revascularization procedures, and more often to have comorbidities,
including heart failure and diabetes.
However, there are now many “loose ends” that challenge
this preoccupation equating obstructive stenosis with
IHD, suggesting that it may be time to rethink this
scientific paradigm.