Trends in Health and Disability 2002 Chief Medical Officer’s Report
The great pitfall of in stent re-stenosis, which has dogged the long term success rate following PCI is likely to become much less of a problem with the introduction of drug eluting stents using either rapamycin or paclitaxel. These stents are to be introduced next year and clinical trials are yet to be undertaken in large volumes to indicate whether their initial promise will be sustained. Furthermore, as technology improves the ability to deal with complex narrowings increases. The challenge remains of managing stenoses involving major side branches and whether any technology can be developed to deal with chronic occlusions.
Management of Risk Factors The role of lipid lowering therapy is now well established in the management of chronic ischaemic heart disease. It is also emerging that unstable coronary syndromes have a more favourable outcome if lipid lowering therapy is introduced aggressively. (It seems that statins pacify unstable plaques). The prevailing view at the ref: 059874 moment is that the lower the cholesterol can be maintained, the better the outcome in patients with The role of stress in established coronary artery disease or in those patients who have additional risk factors (especially a positive the development of family history) for coronary artery disease. coronary artery disease remains The importance of controlling high blood pressure, particularly in the context of diabetes mellitus, has long controversial been established with target levels now being 140/85 or less in non-diabetic patients and 140/80 or less in diabetic patients. The role of stress in the development of coronary artery disease remains controversial. The conventional view that stress unmasks symptoms from pre-existing coronary artery stenosis still prevails. The consequence of this, is that many patients seek early retirement or redeployment in their working life in order to avoid stress and therefore symptoms of angina.
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