Bill is a 58yo male recently diagnosed with stable angina.

Bill is a 58yo male recently diagnosed with stable angina.  He has been experiencing chest pain about 2-3 times per week for the last month.  His chest pain typically occurs while walking, which he does about 3 times each week.  He has no other significant past medical history, takes no medications, has no drug allergies, and does not smoke.  His BP is 122/74, HR 72.  His labs are all normal.  His fasting lipid profile is Total Cholesterol 175, HDL 45, LDL 90, TG 125.  Waist circumference is 30”, and BMI is 24.  His family history is unremarkable. 

  1. What risk factors are present and are they modifiable?
  2. What are the goals of therapy?
  3. What medication(s) do you recommend to prevent Bill from experiencing angina-related chest discomfort and to increase exercise capacity?
  4. What do you recommend to treat acute episodes of stable-angina-related chest discomfort?
  5. What additional medications can improve outcomes (e.g. decreased cardiovascular mortality, non-fatal MI, cardiac arrest, etc.) in a patient like Bill who has stable angina?
  6. What is your drug therapy monitoring plan?
  7. What patient education should you provide?

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