Abstract
Chronic coronary artery disease (CAD) remains a leading cause of global morbidity
and mortality, necessitating a nuanced approach to long-term management. While revascularization
strategies play a crucial role in select high-risk patients, optimal medical therapy
(OMT) is the foundation of care for most individuals with stable disease. This review
critically appraises contemporary pharmacological strategies for CAD, integrating
the latest information from randomized trials and guideline-directed recommendations.
Antihypertensive therapy, particularly renin–angiotensin system inhibitors and beta-blockers,
remains central to reducing myocardial workload and preventing adverse cardiovascular
events. Lipid-lowering agents, including high-intensity statins, ezetimibe, PCSK9
inhibitors, and inclisiran, have redefined risk stratification by demonstrating incremental
reductions in low-density lipoprotein and atherosclerotic progression and event recurrence.
The emergence of novel antidiabetic agents—SGLT2 inhibitors and GLP-1 receptor agonists—has
expanded the therapeutic landscape, offering cardioprotective benefits independent
of glycemic control. Additionally, the growing recognition of inflammation as a driver
of CAD progression has led to the exploration of anti-inflammatory agents such as
colchicine and interleukin-1 beta inhibitors. Landmark trials, including COURAGE,
ISCHEMIA, and FREEDOM, reaffirm the noninferiority of OMT to revascularization in
stable CAD, underscoring the need for an individualized approach. Future directions
encompass precision medicine, artificial intelligence-driven risk stratification,
and gene-based interventions, which may redefine therapeutic paradigms in CAD management.
Keywords
cardiovascular risk - chronic coronary artery disease - inflammation - lipid-lowering
therapy - medical management - precision medicine
