Types - Angina
The types of angina are stable, unstable, microvascular, and variant. The types vary based on their severity or cause.
Stable angina follows a pattern that has been consistent for at least 2 months. That means the following factors have not changed:
- How long your angina events last
- How often your angina events occur
- How well the angina responds to rest or medicines
- The causes or triggers of your angina
If you have stable angina, you can learn its pattern and predict when an event will occur, such as during physical exertion or mental stress. The pain usually goes away a few minutes after you rest or take your angina medicine. If the condition causing your angina gets worse, stable angina can become unstable angina.
Unstable angina does not follow a pattern. It may be new or occur more often and be more severe than stable angina. Unstable angina can also occur with or without physical exertion. Rest or medicine may not relieve the pain.
Unstable angina is a medical emergency, since it can progress to a heart attack. Medical attention may be needed right away to restore blood flow to the heart muscle.
Microvascular angina is a sign of ischemic heart disease affecting the tiny arteries of the heart. Microvascular angina events can be stable or unstable. They can be more painful and last longer than other types of angina, and symptoms can occur during exercise or at rest. Medicine may not relieve of this type of angina.
Variant angina, also known as Prinzmetal’s angina, is rare. It occurs when a spasm—a sudden tightening of the muscles within the arteries of your heart—causes the angina rather than a blockage. This type of angina usually occurs while you are at rest, and the pain can be severe. It usually happens between midnight and early morning and in a pattern. Medicine can ease symptoms of variant angina.
Causes - Angina
Angina happens when your heart muscle does not get enough oxygen-rich blood. Medical conditions, particularly ischemic heart disease, or lifestyle habits can cause angina. To understand the causes of angina, it helps to understand how the heart works.
Ischemic heart disease
Two types of ischemic heart disease can cause angina.
- Coronary artery disease happens when builds up inside the large arteries that supply blood to the heart. This is called . Plaque narrows or blocks the arteries, reducing blood flow to the heart muscle. Sometimes plaque breaks open and causes to form. Blood clots can partially or totally block the coronary arteries.
- Coronary microvascular disease affects the tiny arteries that branch off the larger coronary arteries. Reduced blood flow in these arteries causes microvascular angina. The arteries may be damaged and unable to expand as usual when the heart needs more oxygen-rich blood.
Spasm of the coronary arteries
A spasm that tightens your coronary arteries can cause angina. Spasms can occur whether or not you have ischemic heart disease and can affect large or small coronary arteries. Damage to your heart’s arteries may cause them to narrow instead of widen when the heart needs more oxygen-rich blood.
What happens in the heart during an angina event?
In one day, your heart beats about 100,000 times and pumps about 2,400 gallons of blood throughout your body. To meet this demand, your heart’s cells needs a great deal of oxygen, which is supplied by the large coronary arteries and the tiny arteries that branch off the large arteries. When your heart is working hard, such as during physical activity or emotional stress, its demand for oxygen increases. Angina occurs when there is an imbalance between the heart’s need for oxygen-rich blood and the ability of the arteries to deliver blood to all areas of the heart.
- Treatment will discuss heart-healthy lifestyle changes that your doctors may recommend if you are diagnosed with angina.
Risk Factors - Angina
You may have an increased risk for angina because of your age, environment or occupation, family history and genetics, lifestyle, other medical conditions, race, or sex.
Genetic or lifestyle factors can cause plaque to build up in your arteries as you age. This means that your risk for ischemic heart disease and angina increases as you get older.
Variant angina is rare, but people who have variant angina often are younger than those who have other types of angina.
Environment or occupation
Angina may be linked to a type of air pollution called particle pollution. Particle pollution can include dust from roads, farms, dry riverbeds, construction sites, and mines.
Your work life can increase your risk of angina. Examples include work that limits your time available for sleep, involves high stress, requires long periods of sitting or standing, is noisy, or exposes you to potential hazards such as radiation.
Family history and genetics
Ischemic heart disease often runs in families. Also, people who have no lifestyle-related risk factors can develop ischemic heart disease. These factors suggest that genes are involved in ischemic heart disease and can influence a person’s risk of developing angina.
Variant angina has also been linked to specificchanges.
The more heart disease risk factors you have, the greater your risk of developing angina. The main lifestyle risk factors for angina include:
Other medical conditions
Medical conditions in which your heart needs more oxygen-rich blood than your body can supply increase your risk for angina. They include:
- A racing heart rate or blood vessel damage due to cocaine or methamphetamine use
- Cardiomyopathy, or disease of the heart muscle
- Damage to the heart caused by injury
- Heart failure
- Heart valve disease
- High blood pressure
- Insulin resistance or diabetes
- Low blood pressure
- Metabolic syndrome
- Overweight or obesity
- Unhealthy cholesterol levels
Race or ethnicity
Some groups of people are at higher risk for developing ischemic heart disease and one of its main symptoms, angina. African Americans who have already had a heart attack are more likely than whites to develop angina.
Variant angina is more common among people living in Japan, especially men, than among people living in Western countries.
Angina affects both men and women, but at different ages based on men and women’s risk of developing ischemic heart disease. In men, ischemic heart disease risk starts to increase at age 45. Before age 55, women have a lower risk for heart disease than men. After age 55, the risk rises in both women and men. Women who have already had a heart attack are more likely to develop angina compared with men.
Microvascular angina most often begins in women around the time of menopause.
Screening and Prevention - Angina
Typically, doctors screen for angina only when you have symptoms. However, your doctor may assess your risk factors for ischemic heart disease every few years as part of your regular office visits. If you have two or more risk factors, then your doctor may estimate the chance that you will develop ischemic heart disease, which may include angina, over the next 10 years.
To prevent angina, your doctor may recommend that you adopt heart-healthy lifestyle changes to lower your risk of ischemic heart disease, the most common cause of angina. Heart-healthy lifestyle changes include choosing a heart-healthy eating pattern such as the DASH eating plan, being physically active, aiming for a healthy weight, quitting smoking, and managing stress. You should also avoid using illegal drugs.
- Diagnosis will explain tests and procedures that your doctor may use to confirm that your chest pain is angina and identify what type of angina you have.
- Living With will discuss what your doctor may recommend to prevent your angina from recurring, getting worse, or causing complications.
- Research for Your Health will discuss how we are using current research and advancing research to prevent angina.
- Participate in NHLBI Clinical Trials will explain our open and enrolling clinical studies that are investigating prevention strategies for angina.
Signs, Symptoms, and Complications - Angina
type of angina you have and on whether you are a man or a woman. Angina symptoms can differ in severity, location in the body, timing, and how much relief you may feel with rest or medicines. Since symptoms of angina and of heart attack can be the same, call 9-1-1 if you feel chest discomfort that does not go away with rest or medicine. Angina can also lead to a heart attack and other complications that can be life-threatening.and symptoms vary based on the
Signs and symptoms
Pain and discomfort are the main symptoms of angina. Angina is often described as pressure, squeezing, burning, indigestion, or tightness in the chest. The pain or discomfort usually starts behind the breastbone. Some people say that angina pain is hard to describe or that they cannot tell exactly where the pain is coming from.
Other symptoms include:
- Light-headedness or fainting
- Nausea, or feeling sick in the stomach
- Shortness of breath
Symptoms of angina can be different for women and men. Instead of chest pain, or in addition to it, women may feel pain in the neck, jaw, throat, abdomen, or back. Sometimes this pain is not recognized as a symptom of a heart condition. As a result, treatment for women can be delayed.
Because angina has so many possible symptoms and causes, all chest pain should be checked by a doctor.
Each type of angina has certain typical symptoms. Learn more about the symptoms that are characteristic of each type.
- Discomfort that feels like gas or indigestion
- Pain during physical exertion or mental stress
- Pain that spreads from your breastbone to your arms or back
- Pain that is relieved by medicines
- Pattern of symptoms that has not changed in the last 2 months
- Symptoms that go away within 5 minutes
- Changes in your stable angina symptoms
- Pain that grows worse
- Pain that is not relieved by rest or medicines
- Pain that lasts longer than 20 minutes or goes away and then comes back
- Pain while you are resting or sleeping
- Severe pain
- Shortness of breath
- Pain after physical or emotional stress
- Pain that is not immediately relieved by medicines
- Pain that lasts a long time
- Pain that you feel while doing regular daily activities
- Severe pain
- Shortness of breath
- Cold sweats
- Numbness or weakness of the left shoulder and upper arm
- Pain that is relieved by medicines
- Pain that occurs during rest or while sleeping
- Pain that starts in the early morning hours
- Severe pain
- Vague pain with a feeling of pressure in the lower chest, perhaps spreading to the neck, jaw, or left shoulder
Diagnosis - Angina
Your doctor may diagnose angina based on your medical history, a physical exam, and diagnostic tests and procedures. These tests can help assess whether you need immediate treatment for a heart attack. Some of these tests may help rule out other conditions.
Your doctor will want to learn about your signs and symptoms, risk factors, personal health history, and family health history to determine whether your chest pain is angina or is caused by something else. Other heart and blood vessel problems or problems with your chest muscles, lungs, or digestive system can cause chest pain.
Tell your doctor if you notice a pattern to your symptoms. Ask yourself these questions:
- How long does the pain or discomfort last?
- How often does the pain occur?
- How severe is the pain or discomfort?
- What brings on the pain or discomfort, and what makes it better?
- Where do you feel the pain or discomfort?
- What does the pain or discomfort feel like?
Your doctor will also need information about ischemic heart disease risk factors and other medical conditions you might have, including diabetes and kidney disease. Even if your chest pain is not angina, it can still be a symptom of a serious medical problem. Your doctor can recommend steps you need to take to get medical care.
As part of a physical examination, your doctor will measure your blood pressure and heart rate, feel your chest and belly, take your temperature, listen to your heart and lungs, and feel your pulse.
Diagnostic tests and procedures
Your doctor may have you undergo some of the following tests and procedures.
- Blood tests to check the level of cardiac . Troponin levels can help doctors tell unstable angina from heart attacks. Your doctor may also check levels of certain fats, cholesterol, sugar, and proteins in your blood.
- Chest X-ray to look for lung disorders and other causes of chest pain not related to ischemic heart disease. A chest X-ray alone is not enough to diagnose angina or ischemic heart disease, but it can help rule out other causes.
- angiography to examine blood flow through the coronary arteries. This test can rapidly diagnose ischemic heart disease as the source of your chest pain and help your doctor decide whether a procedure to improve blood flow will benefit your future health.
- Coronary angiography with cardiac catheterization to see if ischemic heart disease is the cause of your chest pain. This test lets your doctor study the flow of blood through your heart and blood vessels to confirm whether plaque buildup is the problem. The results of the scan can also help your doctor assess whether unstable angina might be relieved by surgery or other procedures.
- Echocardiogram to assess the strength of your heart beating, to help the doctor determine your risk of future heart problems.
- Electrocardiogram (EKG) to check for the possibility of a heart attack. Certain EKG patterns are associated with variant angina and unstable angina. These patterns may indicate serious ischemic heart disease or prior heart damage as a cause of angina. However, some people who have angina have normal EKGs.
- Hyperventilation testing to diagnose variant angina. Rapid breathing under controlled conditions with careful medical monitoring may bring on EKG changes that help your doctor diagnose variant angina.
- Magnetic resonance imaging or other noninvasive tests to check for problems with the heart’s movement or with blood flow in the heart’s small blood vessels.
- Provocation tests to diagnose variant angina. Your doctor may give you a medicine such as acetylcholine during coronary angiography to see if the coronary arteries start to spasm.
- Stress testing to assess your heart’s function during exercise. A stress test can show possible signs and symptoms of ischemic heart disease causing your angina. Stress testing in the early morning can help diagnose variant angina. Stress echocardiography tests can help your doctor diagnose the cause of your angina.
Treatment - Angina
Your doctor will decide on a treatment approach based on the type of angina you have, your symptoms, test results, and risk of complications. Unstable angina is a medical emergency that requires immediate treatment in a hospital. If your angina is stable and your symptoms are not getting worse, you may be able to control your angina with heart-healthy lifestyle changes and medicines. If lifestyle changes and medicines cannot control your angina, you may need a medical procedure to improve blood flow and relieve your angina.
If you are diagnosed with angina, your doctor will prescribe fast-acting medicines you can take to control angina events and relieve pain. Often other medicines are also prescribed to help control angina long-term. The choice of medicines may depend on what type of angina you have.
- Anticoagulant medicines, or blood thinners, such as heparin, to prevent dangerous blood clots and future complications, such as a heart attack or another angina event.
- Antiplatelet medicines to prevent blood clots from forming. If you have stable or unstable angina, your doctor may recommend aspirin to treat angina and reduce the risk of complications of ischemic heart disease. Other platelet inhibitors, such as clopidogrel, may also be prescribed.
- Beta blockers to help your heart beat slower and with less force. These drugs are often prescribed to help relieve angina. If you cannot take beta-blockers for some reason, long-acting nitrates are the preferred alternative.
- Calcium channel blockers to keep calcium from entering the muscle cells of your heart and blood vessels. This allows blood vessels to relax. Calcium channel blockers may be an alternative medicine if you are unable to take beta blockers or nitrates. For variant angina, your doctor is likely to order calcium channel blockers and avoid giving you beta blockers.
- Nitrates to widen and relax blood vessels, which allows more blood to flow to the heart while reducing the heart’s workload. Nitrate pills or sprays, including nitroglycerin, act quickly and can relieve pain during an event. Long-acting nitrates are available as pills or skin patches. If you are hospitalized for chest pain, your doctor may order intravenous (IV) nitrates to relieve your angina pain.
- Statins to prevent plaque from forming and to relieve blood vessel spasms or inflammation, reducing the risk of a heart attack or other complications after emergency treatment.
If you still have symptoms or experience side effects, your doctor may prescribe other medicines, including:
- Morphine to relieve pain and help relax the blood vessels. Your doctor may suggest it if other medicines have not helped.
- Ranolazine to help you have angina symptoms less often. When given with other anti-angina medicines, ranolazine can also increase the length of time you can be physically active without pain. This medicine may work for coronary microvascular disease, which causes microvascular angina. Ranolazine may be a substitute for nitrates for men with stable angina who take drugs for erectile dysfunction.
If lifestyle changes and medicines do not control angina, you may need a medical procedure to treat the underlying heart disease.
- Coronary artery bypass grafting (CABG) to treat ischemic heart disease and relieve angina. CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.
- Percutaneous coronary intervention (PCI), also known as coronary angioplasty, to open narrowed or blocked blood vessels that supply blood to the heart. This procedure requires cardiac catheterization. If PCI includes certain medicines to expand coronary arteries, the procedure may be helpful for some people who have variant angina.
- Research for Your Health will explain how we are using current research and advancing research to treat people who have angina.
- Participate in NHLBI Clinical Trials will discuss our open and enrolling clinical studies that are investigating treatments for angina.
- Living With will explain what your doctor may recommend including life-long heart-healthy lifestyle changes and medical care to prevent your condition from recurring, getting worse, or causing complications.
Living With - Angina
Angina is not a heart attack, but it is a signal that you are at greater risk of having a heart attack. The risk is higher if you have unstable angina. For this reason, it is important that you receive follow-up care, monitor your condition, and understand your condition so you know when to get medical help. Your doctor may recommend heart-healthy lifestyle changes and cardiac rehabilitation to help manage angina.
Receive routine follow-up care
You may need follow-up visits every 4 to 6 months for the first year after diagnosis of angina and every 6 to 12 months as long as your condition is stable. Your care plan may be changed if your angina worsens or if stable angina becomes unstable. Unstable angina is a medical emergency.
- Your doctor may recommend cholesterol-lowering statins as part of your long-term treatment, especially if you have had a heart attack.
- Ask your doctor about when you can resume normal physical activity, such as climbing stairs.
- Ask your doctor whether sexual activity is safe for you. People who have unstable angina or angina that does not respond well to treatment should not engage in sexual activity until their heart condition and angina are stable and well managed.
- Talk to your medical team about vaccinations to prevent the flu and pneumonia.
Return to Treatment to review possible treatment options for your angina.
Monitor your condition
To monitor your condition, your doctor may recommend the following tests or procedures:
- Blood pressure checks to ensure that your blood pressure is in a healthy range. Keeping your blood pressure under control can help your angina.
- EKGs to detect changes in heart health after treatment or for monitoring the heart during exercise as part of cardiac rehabilitation.
- Repeat lipid panels to see if blood cholesterol levels are at healthy levels. A lipid panel should be done every year and also 2 to 3 months after any change in treatment.
- Stress testing to assess your risk for complications either before or after starting angina medicines. Stress tests can also make sure your heart is strong enough for physical and sexual activity.
Adopt heart-healthy lifestyle changes
Angina is a symptom of ischemic heart disease. Your doctor may recommend the following heart-healthy lifestyle changes to help you manage angina:
- Heart-healthy eating. Following a healthy eating plan, including limiting alcohol, can prevent or reduce high blood pressure and high blood cholesterol, helping you reduce angina symptoms and maintain a healthy weight. You should avoid large meals and rich foods if heavy meals trigger your angina. If you have variant angina, drinking alcohol can also be a trigger.
- Aiming for a healthy weight. If you have overweight or obesity, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you manage the risk factors for angina.
- Being physically active. Before starting any exercise program, ask your doctor about what level of physical activity is right for you. Slow down or take rest breaks if physical exertion triggers angina.
- Managing stress. If emotional stress triggers your angina, try to avoid situations that make you upset or stressed.
- Quitting smoking. Smoking can damage and tighten blood vessels, make angina worse, and raise the risk of life-threatening complications. Visit Smoking and Your Heart and the NHLBI’s Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you may call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
Your doctor may recommend these heart-healthy lifestyle changes as part of a larger cardiac rehabilitation program that your doctors oversee.
Prevent repeat angina events
Stable angina usually occurs in a pattern. After several events, you will learn what causes the pain to occur, what the pain feels like, and how long the pain usually lasts. To help learn your angina’s pattern and triggers, keep a log of when you feel pain. The log helps your doctor regulate your medicines and evaluate your need for future treatments. When you know what triggers your angina, you can take steps to prevent or lessen the severity of events.
- Know the limits of your physical activity. Most people who have stable angina can continue their normal activities. This includes work, hobbies, and sexual relations. Learn how much exertion triggers your angina so you can try to stop and rest before the chest pain starts.
- Learn how to reduce and manage stress. Try to avoid or limit situations that cause anger, arguments, and worry. Exercise and relaxation can help relieve stress. Alcohol and drug use play a part in causing stress and do not relieve it. If stress is a problem for you, talk with your doctor about getting help.
- Avoid exposure to very hot or cold conditions, because temperature extremes strain the heart.
- Eat smaller meals if large meals lead to chest pain.
Tell your doctor right away if your pattern changes. Pattern changes may include angina that occurs more often, lasts longer, is more severe, occurs without physical exertion, or does not go away with rest or medicines. These changes may be a sign that your symptoms are getting worse or becoming unstable.
Seek help for angina that does not improve
Not all angina improves with medicines or medical procedures. If your symptoms continue, your doctor may change your medicines or therapies to help relieve your chest pain. Additional treatments for hard-to-treat angina include:
- Enhanced external counterpulsation therapy (EECP) to improve the flow of oxygen-rich blood to your heart muscle, which may help relieve angina. EECP uses large cuffs, similar to blood pressure cuffs, on your legs. The cuffs inflate and deflate in sync with your heartbeat. You typically get five 1-hour treatments per week for 7 weeks. Side effects may include back or neck pain and skin abrasions.
- Spinal cord stimulators to block the sensation of pain. Emerging research suggests that this technology can help people be more physically active, feel angina less often, and have a better quality of life.
- Transmyocardial laser therapy to stimulate growth of new blood vessels or improve blood flow in the heart muscle. It can relieve angina pain and increase your ability to exercise without discomfort. This laser-based treatment is done during open-heart surgery or through cardiac catheterization. Rarely, your doctor may recommend this treatment in combination with CABG.
Know your medicines
You should know what medicines you are taking, the purpose of each, how and when to take them, and possible side effects. Learn exactly when and how to take nitroglycerin or other short-acting nitrates to relieve chest pain. Then talk to your doctor about the following:
- Any other medicines you are taking, including vitamins and nutritional supplements. Some medicines can cause serious or life-threatening problems if they are taken with nitrates or other angina medicines. For example, men who take nitrates, including nitroglycerin, for their angina should not take medicines for erectile dysfunction without checking with their doctor first.
- Any side effects you may experience. Do not stop taking your medicines without talking to your doctor first.
- How to store your medicines correctly and when to replace them.
What’s the safest and most effective way to use short-acting nitrates like nitroglycerin to treat stable angina events?
Here are some tips for taking short-acting nitrates.
- Use the short-acting nitrate immediately before any planned exercise or physical exertion.
- Watch for side effects such as flushing, headache, or dizziness. Find a place to sit down or something to hold on to if you feel dizzy.
- After 5 minutes, if the pain has not gone away, take another dose.
Call 9-1-1 if the pain continues after taking a second dose. This could be a symptom of unstable angina, which is a medical emergency.
Learn the warning signs of serious complications and have a plan
Sometimes it is hard to tell the difference between unstable angina and a heart attack. Angina can be a sign of increased risk of stroke. Angina can also trigger sudden cardiac arrest. These are medical emergencies.
If you think that you or someone else is having the following symptoms, call 9-1-1 immediately. Every minute matters.
Signs of heart attack include mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes, or goes away and comes back. It can feel like pressure, squeezing, fullness, heartburn, or indigestion. There may also be pain down the left arm. Women may also have chest pain and pain down the left arm, but they are more likely to have symptoms such as shortness of breath, nausea, vomiting, unusual tiredness, and pain in the back, shoulders, or jaw. Read more about the signs and symptoms of a heart attack.
If you think someone may be having a stroke, act F.A.S.T. and do the following simple test.
F—Face: Ask the person to smile. Does one side of the face droop?
A—Arms: Ask the person to raise both arms. Does one arm drift downward?
S—Speech: Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?
T—Time: If you observe any of these signs, call 9-1-1 immediately. Early treatment is essential.
Read more about the signs and symptoms of a stroke.
Sudden cardiac arrest
It is possible for a spasm causing angina to trigger arrhythmia. This can lead to sudden cardiac arrest. Fainting is usually the first sign of sudden cardiac arrest. If you think someone may be in cardiac arrest, try the following steps.
- If you see a person faint or if you find a person already unconscious, first confirm that the person cannot respond. The person may not move, or his or her movements may look like a seizure.
- You can shout at or gently shake the person to make sure he or she is not sleeping, but never shake an infant or young child. Instead, you can gently pinch the child to try to wake him or her up.
- Check the person’s breathing and pulse. If the person is not breathing and has no pulse or has an irregular heartbeat, prepare to use an automated external defibrillator as soon as possible.
Research for Your Health
Improving health with current research
Learn about the following ways the NHLBI continues to translate current research into improved health for people who have angina. Research on this topic is part of the NHLBI’s broader commitment to advancing Heart and Vascular Disease scientific discovery.
- Angina as a Predictor of Future Complications After Heart Attack. The NHLBI’s landmark multigenerational Framingham Heart Study found that angina was twice as common among patients who later had heart attacks with symptoms as it was in patients who had silent heart attacks. Angina, either before or after a heart attack, predicted future heart attacks and other complications of ischemic heart disease.
- Increased Risk of Unstable Angina Among Women Who Have Certain Risk Factors. The Women’s Health Initiative, an important NHLBI study, followed more than 92,000 postmenopausal women for nearly 5 years to identify risk factors for unstable angina or heart attack. Scientists found that women who had high blood cholesterol or a history of ischemic heart disease were more likely to develop unstable angina.
- Angina Medicine’s Benefit for Patients Who Have Life-Threatening Abnormal Heart Rhythms. The RAID Trial found that a medicine to treat angina reduced the risk of rapid heart rhythms that otherwise might have required an implantable cardioverter defibrillator.
- Evaluating Patients Who Have Chest Pain More Quickly. The NHLBI-sponsored Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography (ROMICAT II) study showed that cardiac CT scans can help emergency room personnel more quickly assess patients who have chest pain. Visit CT Angiography Speeds Emergency Diagnosis of Heart Disease in Low-Risk Patients to learn more.
- Patient-Reported Measures Show Benefits of Coronary Artery Bypass Grafting, Percutaneous Coronary Intervention. The NHLBI’s Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease (FREEDOM) trial compared CABG treatment and PCI treatment for people who have multiple blocked coronary arteries and diabetes. The study showed that people reported improvement in angina symptoms and better quality of life with both CABG and PCI procedures with stents that have a coating of medicine, although the time period during which each method was most effective differed.
Advancing research for improved health
In support of our mission, we are committed to advancing angina research, in part, through the following ways.
- We perform research. Our Division of Intramural Research, which includes investigators from our Cardiovascular Branch, performs research on ischemic heart disease, which can lead to angina.
- We fund research. The research we fund today will help improve our future health. Our Division of Cardiovascular Sciences, which includes the Adult and Pediatric Cardiac Research Program, oversees much of the research on ischemic heart disease—the leading cause of angina—we fund. This is helping us to understand, prevent, and manage angina. It also supports research aimed at preventing and treating pediatric and adult cardiovascular diseases. The Center for Translation Research and Implementation Science, and its Health Inequities and Global Health Branch, seeks to stimulate global health research, education, and training for many conditions, including ischemic heart disease and angina. Search the NIH RePORTer to learn about research the NHLBI is funding on angina.
- We stimulate high-impact research. Our Trans-Omics for Precision Medicine (TOPMed) program now includes participants with ischemic heart disease and may help us understand how genes contribute to differences in disease severity and how patients respond to treatment. The NHLBI Strategic Vision highlights ways in which we may support research over the next decade.
Learn about exciting research areas the NHLBI is exploring about angina.
- Blood cells investigated as new treatment for microvascular angina. Treatments for coronary microvascular disease are limited. We are supporting a study evaluating the use of cell therapy as a way to improve blood flow in the heart and reduce angina events in people who have coronary microvascular disease.
- Counseling may help reduce smokers’ risk of depression and unstable angina. More than 400,000 smokers experience unstable angina or heart attack each year. We are funding a research project to see if a counseling program can help reduce depression among people who have had unstable angina or a heart attack and help them quit smoking and avoid future complications.
- Medical records could reveal better treatment approaches for people who have angina and . Procedures to remove blockages in coronary arteries may improve angina symptoms but may increase the risk that people who have chronic kidney disease will have to start dialysis. We are supporting a data analysis that will compare treatment with medicines to procedures, such as CABG and PCI, in people who have angina and chronic kidney disease.
- Plaque proteins are a new target for atherosclerosis treatments. Plaque can block blood flow to the heart and lead to angina. Cells called macrophages help clear away the plaque that builds up in blood vessels, but it is not clear how they do so. NHLBI investigators recently identified a protein in plaque that repels macrophages, allowing plaque to accumulate. In mice, blocking this protein reduced the formation of plaque. These findings suggest that the protein, called CD47, is a new target for potential atherosclerosis treatments.
- Research may help improve imaging for coronary microvascular disease diagnosis. The tiny arteries of the heart are too small to visualize with most existing imaging procedures, making it difficult to diagnose microvascular angina. We are supporting research to refine a noninvasive imaging technology called cardiac magnetic resonance first-pass myocardial perfusion imaging to allow more accurate measurement of blood flow in the tiny arteries.
- Sedentary behavior may complicate recovery from unstable angina. Being sedentary increases the risk of serious health problems, including unstable angina, heart attack, and death. People who have had unstable angina or a heart attack tend to further decrease their activity levels. This study will track activity levels of people after they have serious complications of ischemic heart disease, including unstable angina events.
- Short-term therapy does not relieve unstable angina in postmenopausal women. We are interested in testing new treatments for angina to be sure that they help people who have this health condition. We supported research showing that hormone treatment did not reduce unstable angina symptoms, hospitalizations, or other ischemic heart disease complications.
Participate in NHLBI Clinical Trials
We lead or sponsor studies on angina. See if you or someone you know is eligible to participate in our.
Trials at the NIH Clinical Center
Evaluating heart conditions
To learn more about clinical trials at the NIH Clinical Center or to talk to someone about a study that might fit your needs, call the Office of Patient Recruitment 800-411-1222.
Do you have diabetes and a history of heart attack?
After reading our Angina Health Topic, you may be interested in additional information found in the following resources.
Related Health Topics
- Aim for a Healthy Weight
- Cardiovascular Health Study
- Framingham Heart Study
- Heart & Vascular Diseases
- Hispanic Community Health Study/Study of Latinos
- International Study of Comparative Health Effectiveness with Medical and Invasive Approaches
- Jackson Heart Study
- Population and Epidemiology Studies
- Strong Heart Study
- The Heart Truth®
- Women’s Health
- Women's Health Initiative
- Angina (National Library of Medicine [NLM], MedlinePlus)
- Angina in Women (American Heart Association)
- Angina Pectoris (American Heart Association)
- Coronary Artery Disease (NLM, MedlinePlus)
- Heart Attack (NLM, MedlinePlus)
- Microvascular Angina (American Heart Association)
- Unstable Angina (American Heart Association)
- Variant Angina (American Heart Association)