Which intervention has been shown to decrease mortality in patients with stable angina?

• A. Aspirin
• B. Clopidogrel (Plavix)
• C. Warfarin (Coumadin)
• D. Enalapril (Vasotec)

Answer: (A)

In stable angina, the main way to reduce death risk is to prevent clot formation on ruptured atherosclerotic plaques. Aspirin does this by irreversibly inhibiting platelet cyclooxygenase-1, which lowers thromboxane A2 and reduces platelet aggregation. This antiplatelet effect directly lowers the chance of a myocardial infarction and related death in patients with coronary artery disease.

Among the options, aspirin has the most consistent evidence showing a mortality benefit in stable angina. Clopidogrel can reduce cardiovascular events, but its mortality benefit in stable angina isn’t as robust on its own. Warfarin increases bleeding risk without clear mortality advantage in stable angina. Enalapril can reduce mortality in high-risk vascular patients or those with heart failure, but aspirin’s effect on mortality in stable CAD is the most well established and widely applied.