Ischaemic heart disease: pathophysiology, diagnosis, and therapeutic strategies

Ischaemic heart disease is the most prevalent cardiovascular disease, accounting for high global mortality. Ischaemic heart disease is a pathological condition characterised by a mismatch between myocardial oxygen supply and demand, caused by reduced cardiac blood flow due to atherosclerotic obstruction or microvascular dysfunction. Atherosclerotic plaques in the arterial lumen form blockages in the arteries. Risk factors include hypertension and hyperlipidaemia, exacerbated by modifiable risks such as smoking, diet and stress. Ischaemic heart disease can be classified as stable ischaemic heart disease (chronic coronary syndrome) and acute coronary syndrome, which is further divided as unstable angina, ST- elevation myocardial infarction and non-ST elevation myocardial infarction. Ischaemic heart disease is a preventable disease that can potentially be eradicated through effective management of risk factors. The dynamic process can be influenced by lifestyle modifications (smoking cessation, diet and stress management), pharmacological interventions (antiplatelet therapy and cholesterol-lowering agents) and revascularisation procedures (percutaneous coronary intervention and coronary artery bypass grafting). Pharmacological interventions aim at preventing clot formation and prevention and stabilisation of plaques in the arterial lumen. Comorbidities such as hypertension must be optimally managed to reduce the workload and oxygen demand of the myocardium. Medicine such as statins, ACE-I and β-blockers are essential for the management of ischaemic heart disease. The aim of this paper is to provide an update on the management of ischaemic heart disease, and to describe the role of the pharmacist in prevention of modifiable risk factors and management of established ischaemic heart disease.