Lifestyle Changes

Regular exercise reduces the frequency of anginal symptoms, increases functional capacity, and improves endothelial function. Patients with chronic stable angina who are receiving medical therapy should exercise regularly, beginning at low levels for 20 to 30 minutes and increasing as symptoms allow. A recent randomized trial that compared the effects of daily exercise with those of angioplasty and stenting among patients with chronic stable angina and single-vessel coronary artery disease demonstrated better outcomes (in terms of major adverse events and improved exercise capacity) at one year in the exercise group than in the revascularization group.

Although dietary modification has not been studied specifically in patients with chronic stable angina, in a trial involving patients with a history of myocardial infarction who had been randomly assigned to follow either a Mediterranean diet or a prudent Western diet, the rate of cardiovascular events was 47 percent lower in the Mediterranean-diet group than in the Western-diet group, and this difference persisted for four years. Trials involving multifactorial risk modification, including exercise, a low-fat diet, and smoking cessation, have demonstrated improvements in the progression of angina and coronary disease.

Vigorous efforts at smoking cessation and weight control are mandatory in patients with chronic stable angina. For patients with Diabetes, a multifactorial approach that includes lifestyle changes and medications for glycemic control and coronary risk factors substantially reduces the risk of cardiovascular events.