Ischemic heart disease

Ischaemic heart disease is a highly prevalent disease, resulting mainly from the development of coronary atherosclerotic plaques that reduce the ability of these arteries to supply oxygenated blood to the heart tissue.

The typical symptom is angina, which occurs when the oxygen supply to the myocardium is insufficient to meet its oxygen demands, and thus the heart undergoes what is called ischaemia. The clinical manifestations of ischaemic heart disease are diverse ranging from exertion-induced angina (or stable angina, when anginal symptoms occur after physical exertion) to angina at rest (or unstable angina) and myocardial infarction, where areas of heart muscle undergo death (necrosis) as a result of a marked and prolonged ischaemia.

An approximate estimate of the prevalence of ischaemic heart disease in Italy can be obtained using the data recently published by the Italian National Observatory on Cardiovascular Diseases; these data indicate that, even if one considers only the most striking manifestations of coronary artery disease, i.e. acute myocardial infarction and angina pectoris, the calculated prevalence of this condition in the Italian population is about 4.8% in males and 4.3% in females, in individuals between 35 and 65 years of age, with these figures rising to 11%-20% in men and 10%-15% in women in the age group over 65 years.

Stable angina is frequently observed in the primary care setting. Recent Italian data confirm the socio-economic impact of angina in terms of general practitioner (GP) visits, with a significant number of contacts/patient/year. Persistence of angina is commonly observed after revascularization, as demonstrated by the high number of patients who continue to take antianginal drugs and/or still complain of angina. In particular, it has been estimated that, one year after a percutaneous coronary intervention (PCI), performed for symptomatic relief or for the treatment of an acute myocardial infarction, the overall prevalence of “residual” angina is about 26%. These data are confirmed by the fact that, in clinical trials evaluating the use of antianginal drugs before and after revascularization, it was shown that many patients continued to take antianginal drugs, even after a considerable period of time following revascularization. The goal of treatment for chronic ischaemic heart disease should be the complete or near-complete elimination of anginal chest pain, and a return to normal activities and a satisfactory functional capacity; this goal should be accomplished with minimal side effects of therapy, and with prevention of myocardial infarction events and improved long-term survival.