This post was authored by Julio A. Panza, MD, FACC, editor of the Chronic Angina CardioSource Clinical Community.

Atherosclerotic heart disease is universally recognized as the number one killer of both men and women in the Western world.  Although in the life of a patient, coronary artery disease is mostly in the quiescent or stable clinical phase, basic and clinical research over the last few decades has been largely focused on the unstable forms of clinical presentation.  This is understandable because the acute presentations of the disease are those that largely explain the increased mortality and morbidity.

However, the attention is now shifting back to stable ischemic heart disease (SIHD), where there have been relatively few advances in recent years, both in terms of our understanding of the mechanisms leading to coronary plaque rupture as well as in the development of new forms of therapy.  In fact, perhaps the most frequently used and certainly most expensive treatment of SIHD –namely, the placement of a stent during percutaneous coronary revascularization (PCI)—has been under increasing scrutiny because of the lack of demonstrated superiority compared to optimal medical therapy and because of its inappropriate use in an important minority of patients.  The recent publication of national guidelines for the management of SIHD patients just a few months ago underscores the significance placed by the cardiology community on this phase of the disease.

The Chronic Angina Clinical Community on CardioSource.org aims to provide a forum for the discussion of relevant topics related to SIHD, including the most important publications in this area and clinical aspects where controversy may exist regarding the best approach for diagnosis and treatment.  The first issue includes a perspective on the FAME 2 trial published last September and raises the possibility of an alternative interpretation of this important study.  The case challenge provides a discussion of a seemingly simple case in which the initial approach is likely to vary significantly among different physicians.

We know that our goals as physicians are to improve the quality and to prolong the life of our patients.  However, achieving that mission in the context of a disease that is epidemic in its prevalence, insidious in its onset, clinically silent most of the time, and potentially fatal in its acute presentations, is a tremendous challenge. Our hope is to facilitate the discussion about the stable forms of coronary artery disease to enhance our collective knowledge and to attempt to resolve controversial issues among practitioners.

For more information about the new Chronic Angina Clinical Community visit CardioSource.org.

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