Chronic stable angina initial laboratory tests

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor(s)-in-Chief: ; Smita Kohli, M.D.;

Overview
In patients with chronic stable angina, initial laboratory investigations are used to: identify potential causes of ischemia, establish risk factors, and determine the overall prognosis for the patient. An initial laboratory test can provide a wide variety of clinical information. For instance, low hemoglobin levels can cause ischemia. Therefore, assessing hemoglobin as a part of complete blood count provides prognostic information. Biomarkers, such as troponin and CK-MB, are used to exclude myocardial injury. In assessment for risk factor stratification, all patients with ischemic heart disease are recommended to have a a standard round of blood work conducted including fasting plasma glucose levels and a complete lipid profile. Serum creatinine is used to assess renal dysfunction due to associated hypertension or diabetes and remains a negative prognostic factor. In patients with chronic stable angina, an elevation in fasting glucose independently predicts the adverse outcome. Recent research on NT-pro-BNP has demonstrated the ability to predict long-term mortality in patients with chronic stable angina independent of age, ventricular ejection fraction and other risk factors.

Initial laboratory tests

 * Total Cholesterol, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) measurements should be performed in all patients with suspected or documented ischemic heart disease.


 * Fasting glucose level


 * Routine hematologic tests are necessary to exclude significant anemia.


 * Thyroid function tests are necessary to exclude abnormal thyroid functions, which can be associated with worsening angina.


 * Homocysteinemia has been found to be a risk factor for coronary artery disease. Folate, vitamin B12 and vitamin B6 can lower the homocysteine level. Although the therapeutic implications of lowering homocysteine levels have not been fully defined, homocysteine concentrations should be measured in patients with a strong family history of coronary disease, especially if it is not explained by traditional risk factors.


 * Fibrinogen: Elevated fibrinogen levels are associated with higher risks of coronary artery disease, but in practice, coagulation studies are not recommended.

==ACC / AHA Guidelines- Recommendations for Initial Laboratory Tests for Diagnosis (DO NOT EDIT) == {{cquote|

Class I
1. Hemoglobin. (Level of Evidence: C)

2. Fasting glucose. (Level of Evidence: C)

3. Fasting lipid panel, including total cholesterol, HDL cholesterol, triglycerides, and calculated LDL cholesterol. (Level of Evidence: C)}}

==ESC Guidelines- Laboratory investigation in initial assessment of stable angina (DO NOT EDIT) == {{cquote|

Class I (in all patients)
1. Fasting lipid proﬁle, including total cholesterol, LDL, HDL, and triglycerides. (Level of Evidence: B)

2. Fasting glucose. (Level of Evidence: B)

3. Full blood count including Hemoglobin and white cell count. (Level of Evidence: B)

4. Creatinine. (Level of Evidence: C)

Class I (if speciﬁcally indicated on the basis of clinical evaluation)
1. Markers of myocardial damage if evaluation suggests clinical instability or ACS. (Level of Evidence: A)

2. Thyroid function if clinically indicated. (Level of Evidence: C)

Class IIa
1. Oral glucose tolerance test. (Level of Evidence: B)

Class IIb
1. Hs-C-reactive protein. (Level of Evidence: B)

2. Lipoprotein a, ApoA, and ApoB. (Level of Evidence: B)

3. Homocysteine. (Level of Evidence: B)

4. HbA1c. (Level of Evidence: B)

5. NT-BNP. (Level of Evidence: B)}}

==ESC Guidelines- Blood tests for routine reassessment in patients with chronic stable angina (DO NOT EDIT) == {{cquote|

Class IIa
1. Fasting lipid proﬁle and fasting glucose on an annual basis. (Level of Evidence: C)}}

Vote on and Suggest Revisions to the Current Guidelines

 * The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Guidelines Resources

 * The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina


 * Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology


 * TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina


 * The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina