Promising new approaches to chronic, stable angina: An advance look at possible future options

Principles of managing stable angina pectoris include the reduction of myocardial oxygen demand and the enhancement of myocardial blood flow. Traditional therapies are effective in most patients, but some novel therapies, now in use predominantly outside the United States, offer the promise of effective treatment for patients in whom traditional therapies are not successful or are poorly tolerated. These therapies aim to reduce myocardial oxygen consumption, improve both endothelial function and myocardial blood flow, provide metabolic support of ischemic myocardium, or decrease the atherosclerotic process. Modalities such as electrical neurostimulation, external counterpulsation, and transmyocardial laser revascularization also may produce marked clinical improvement.