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Angina pectoris och obstruktiv kranskärlssjukdom

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Sakkunnig:
Definition:
Stabil angina pectoris är en symtombild vid obstruktiv kranskärlssjukdom. Kroniskt koronart syndrom är ett paraplybegrepp på långvarig sjukdom i koronarartärerna, där angina pectoris är en vanlig presentation.
Förekomst:
Cirka 5 % vid 50 års ålder till cirka 10–14 procent vid 75 års ålder.
Symtom:
Obehag/smärta/tryckkänsla/kramande känsla/brännande känsla i bröstet som kan utstråla till arm, käke, hals och rygg. Dyspné förekommer. Symtomen utlöses av till exempel fysisk ansträngning.
Kliniska fynd:
Oftast få vid stabil angina pectoris.
Diagnostik:
Val av diagnostisk metod beror på vilken risk patienten har för obstruktiv kranskärlssjukdom. Det beror i sin tur på symtom, ålder, kön och vissa faktorer som gör tillståndet mer eller mindre sannolikt. 
Behandling:
Består i regel av hälsosamma levnadsvanor, läkemedelsbehandling och i vissa fall kirurgisk behandling.
  1. Knuuti J, Wijns W, Saraste A, et al. 2019 Guidelines on Chronic Coronary Syndromes. European Society of Cardiology. European Heart Journal, ehz425. DOI:10.1093/eurheartj/ehz425. DOI  
  2. Holm A, Hofmann R, Andersen K, et al. »Stabil kranskärlssjukdom« blir »kroniskt koronart syndrom«. Läkartidningen 2020; 117: FWAZ. www.lakartidningen.se  
  3. Abrams J. Chronic stable angina. N Engl J Med 2005; 352: 2524-33. PubMed  
  4. Forsberg L, Persson J, Nygren AT. ABC om icke-invasiv diagnostik vid stabil kranskärls­sjukdom. Läkartidningen. 2016;113:D6TU. www.lakartidningen.se  
  5. Socialstyrelsen. Statistikdatabas. Diagnoser i specialiserad öppen vård. (Hämtad 2019-09-03) www.socialstyrelsen.se  
  6. Swedeheart. Årsrapport 2018. (Hämtad 2019-09-03). www.ucr.uu.se  
  7. Swedeheart. SWEDEHEART Annual Report 2018 Cardiac surgery Appendix. (Hämtad 2019-09-03). www.ucr.uu.se  
  8. Schoenhagen P, Ziada RM, Kapadia SP, Crowe TD, Nissen SE, Tuzcu EM. Extent and direction of arterial remodeling in stable versus unstable coronary syndromes: an intravascular ultrasound study. Circulation 2000; 101: 598-603. Circulation  
  9. Halcox JP, Schenke WH, Zalos G, et al. Prognostic value of coronary vascular endothelial dysfunction. Circulation 2002; 106: 653-8. Circulation  
  10. Opie LH, Commerford PJ, Bersh BJ. Controversies in stable coronary artery disease. Lancet 2006; 367: 69-78. PubMed  
  11. Rosengren A, Hawken S, Ôunpuu S, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 953-62. PubMed  
  12. Bogers RP, Bemelmans WJ, Hoogenveen RT, et al. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: A meta-analysis of 21 cohort studies including more than 300 000 persons. Arch Intern Med 2007; 167: 1720-8. PubMed  
  13. Lakka H-M, Lakka TA, Tuomilehto J, Salonen JT. Abdominal obesity is associated with increased risk of acute coronar events in men. Eur Heart J 2002; 23: 706-13. PubMed  
  14. Yusuf S, Hawken S, Ôunpuu S et al. Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study. Lancet 2005; 366: 1640-9. PubMed  
  15. McGill HC, McMahan A, Herderick EE, Zieske AW, Malcom GT, Tracy RE, Strong JP, for the pathobiological determinants of atherosclerosis in youth (PDAY) research group. Obesity accelerates the progression of coronary atherosclerosis in young men. Circulation 2002; 105: 2712-8. PubMed  
  16. Tirosh A, Shai I, Tekes-Manova D et al. Normal fasting plasma glucose levels and type 2 diabetes in young men. N Engl J Med 2005; 353: 1454-62. New England Journal of Medicine  
  17. Sattar N, Gaw A, Scherbakova O, et al. Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation 2003; 108: 414-9. Circulation  
  18. Prior JO, Quinones MJ, Hernandez-Pampaloni M, et al. Coronary circulatory dysfunction in insulin resistance, impaired glucose tolerance, and type 2 diabetes mellitus. Circulation 2005; 111: 2291-8. Circulation  
  19. El Khoudary SR, Aggarwal B, Beckie TM et al.; American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention; and Council on Cardiovascular and Stroke Nursing. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020 Dec 22;142(25):e506-e532. Epub 2020 Nov 30. PMID: 33251828 PubMed  
  20. Schef KW, Tornvall P, Alfredsson J, et al. Prevalence of angina pectoris and association with coronary atherosclerosis in a general population. Heart 2023. pmid:37225242 PubMed  
  21. Boesner S, Haasenritter J, Becker A, et al. Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule. CMAJ 2010;182: 1295–1300. PMID:20603345. PubMed  
  22. Läkemedelsverket. Att förebygga aterosklerotisk hjärt-kärlsjukdom med läkemedel - behandlingsrekommendation. 5:2014. (Hämtad 2019-09-03) lakemedelsverket.se  
  23. Nationella riktlinjer för hjärtsjukvård. Socialstyrelsen (2018). www.socialstyrelsen.se  
  24. SBU. Hjärta – Rätt använd kan datortomografi utesluta förträngda kranskärl. 2011-06-15 (hämtad 2019-02-13) www.sbu.se  
  25. Hauggaard A, Kjellin M, Olsson SE. Ny metod prövad för att minska behovet av invasiv koronarangiografi. Läkartidningen. 2018;115:E396. www.lakartidningen.se  
  26. Maffei E, Seitun S, Martini C, et al. CT coronary angiography and exercise ECG in a population with chest pain and low-to-intermediate pre-test likelihood of coronary artery disease. Heart 2010; 96: 1973-9. PubMed  
  27. Mordi IR, Badar AA, Irving RJ, et al. Efficacy of noninvasive cardiac imaging tests in diagnosis and management of stable coronary artery disease. Vasc Health Risk Manag 2017; 13: 427-437. pmid:29200864 PubMed  
  28. DISCHARGE Trial Group, Maurovich-Horvat P, Bosserdt M, et al. CT or Invasive Coronary Angiography in Stable Chest Pain published online ahead of print, 2022 Mar 4. N Engl J Med. PMID:35240010. PubMed  
  29. Region Skåne, HTA Skåne. Arbetsprov vid misstänkt kronisk kranskärlssjukdom. 202-10-07. vardgivare.skane.se  
  30. Sekhri N, Feder GS, Junghans C, et al. Incremental prognostisc value of the exercise electrocardiogram in the initial assessment of patients with suspected angina: cohort study. BMJ 2008; 337: a2240. PubMed  
  31. Ohman EM. CLINICAL PRACTICE. Chronic Stable Angina. N Engl J Med. 2016;374(12):1167-76 PubMed  
  32. Nilsson G, Mooe T, Stenlund H, Samuelsson E . Diagnostic characteristics and prognoses of primary-care patients referred for clinical exercise testing: a prospective observational study. BMC Fam Pract 2014; Apr 18;15: 71. pmid:24742057. PubMed  
  33. US Preventive Services Task Force. Screening for Cardiovascular Disease Risk With Electrocardiography. US Preventive Services Task Force Recommendation Statement. JAMA 2018; 319: 2308-14. pmid: 29896632 PubMed  
  34. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal 2019; 00: 1-78. doi:10.1093/eurheartj/ehz455 DOI  
  35. Al-Lamee RK, Nowbar AN, Francis DP. Percutaneous coronary intervention for stable coronary artery disease. Heart 2019; 105(1): 11-19. pmid:30242142 PubMed  
  36. Maron DJ, Hochman JS, Reynolds HR, et al. Initial Invasive or Conservative Strategy for Stable Coronary Disease. N Engl J Med 2020; 382: 1395-407. pmid:32227755 PubMed  
  37. Beauchamp A, Talevski J, Niebauer J, et al. Health literacy interventions for secondary prevention of coronary artery disease: a scoping review. Open Heart 2022; 9: e001895. pmid:35064057 PubMed  
  38. Critchley JA, Capewell S. Mortality risk reduction associated with smoking cessation in patients with coronary heart disease: a systematic review. JAMA 2003; 290(1): 86-97. pmid:12837716 PubMed  
  39. Iestra JA, Kromhout D, van der Schouw YT, Grobbee DE, Boshuizen HC and van Staveren WA. Effect size estimates of lifestyle and dietary changes on all-cause mortality in coronary artery disease patients: a systematic review. Circulation 2005; 112: 924-34. Circulation  
  40. Abdelhamid AS, Brown TJ, Brainard JS, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2018; 7: CD003177. doi:10.1002/14651858.CD003177.pub3 DOI  
  41. Pack QR, Rodriguez-Escudero JP, Thomas RJ, et al. The prognostic importance of weight loss in coronary artery disease: a systematic review and meta-analysis. Mayo Clin Proc 2014; 89(10): 1368-77. pmid:25199859 PubMed  
  42. Anderson L, Taylor RS. Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2014 Dec 12;12:CD011273. doi: 10.1002/14651858.CD011273.pub2. The Cochrane Library  
  43. FYSS 2017. Kranskärlssjukdom. 2016-11-24 (hämtad 2019-09-04) www.fyss.se  
  44. Vivekananthan DP, Penn MS, Sapp SK, Hsu A, Topol EJ. Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomised trials. Lancet 2003; 361: 2017-23. PubMed  
  45. Husted SE, Ohman EM, et al. Pharmacological and emerging therapies in the treatment of chronic angina. Lancet. 2015 Aug 15;386(9994):691-701. PubMed  
  46. Yasuda S, Kaikita K, Akao M, et al. Antithrombotic Therapy for Atrial Fibrillation with Stable Coronary Disease. N Engl J Med 2019. pmid:31475793 PubMed  
  47. Naito R, Miyauchi K, Yasuda S, et al. Rivaroxaban Monotherapy vs Combination Therapy With Antiplatelets on Total Thrombotic and Bleeding Events in Atrial Fibrillation With Stable Coronary Artery Disease A Post Hoc Secondary Analysis of the AFIRE Trial. JAMA Cardiol 2022. pmid:35704345 PubMed  
  48. Eikelboom JW, Connoly SJ, Bosch J, et al. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med 2017. doi:10.1056/NEJMoa1709118 DOI  
  49. Connolly SJ, Eikelboom JW, Bosch J, et al. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 2018; 391(10117): 205-218. pmid:29132879 PubMed  
  50. Al-Lamee R, Davies J, Malik IS. What is the role of coronary angioplasty and stenting in stable angina?. BMJ 2016; Feb 5;352: i205. pmid:26850069 PubMed  
  51. The Time Investigators. Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial. Lancet 2001; 358: 951-7. PubMed  
  52. Lied A, Morstøl TH, Vik-Mo H. Koronar angioplastikk hos eldre pasientar. Tidsskr Nor Lægeforen 2002; 122: 1266-9. PubMed  
  53. Hlatky MA, Boothroyd DB, Bravata DM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials . Lancet 2009; 373: 1190-7. PubMed  
  54. Windecker S, Stortecky S, Stefanini GG, et al. Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis. BMJ 2014; 348:g3859. BMJ (DOI)  
  55. Gersh BJ and Frye RL. Methods of coronary revascularization - things may not be as they seem. N Engl J Med 2005; 352: 2235-7. New England Journal of Medicine  
  56. Whooley MA, de Jonge P, Vittinghoff E et al. Depressive symptoms, helath behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA 2008; 300: 2379-88. Journal of the American Medical Association  
  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas

Tidigare sakkunniga

  • Eva Swahn, professor och överläkare, Kardiologiska kliniken, Universitetssjukhuset Linköping