{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T14:06:21Z","timestamp":1769609181731,"version":"3.49.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,2,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">In stable coronary artery disease, medications are used for 2 purposes: cardiovascular risk reduction and symptom improvement. In clinical trials and clinical practice, medication use is often not optimal. The ORBITA (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) trial was the first placebo\u2010controlled trial of percutaneous coronary intervention. A key component of the ORBITA trial design was the inclusion of a medical optimization phase, aimed at ensuring that all patients were treated with guideline\u2010directed truly optimal medical therapy. In this study, we report the medical therapy that was achieved.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">After enrollment into the ORBITA trial, all 200 patients entered a 6\u2010week period of intensive medical therapy optimization, with initiation and uptitration of risk reduction and antianginal therapy. At the prerandomization stage, the median number of antianginals established was 3 (interquartile range, 2\u20134). A total of 195 patients (97.5%) reached the prespecified target of \u22652 antianginals; 136 (68.0%) did not stop any antianginals because of adverse effects, and the median number of antianginals stopped for adverse effects per patient was 0 (interquartile range, 0\u20131). Amlodipine and bisoprolol were well tolerated (stopped for adverse effects in 4\/175 [2.3%] and 9\/167 [5.4%], respectively). Ranolazine and ivabradine were also well tolerated (stopped for adverse effects in 1\/20 [5.0%] and 1\/18 [5.6%], respectively). Isosorbide mononitrate and nicorandil were stopped for adverse effects in 36 of 172 (20.9%) and 32 of 141 (22.7%) of patients, respectively. Statins were well tolerated and taken by 191 of 200 (95.5%) patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In the 12\u2010week ORBITA trial period, medical therapy was successfully optimized and well tolerated, with few drug adverse effects leading to therapy cessation. Truly optimal medical therapy can be achieved in clinical trials, and translating this into longer\u2010term clinical practice should be a focus of future study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT02062593.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.017381","type":"journal-article","created":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T10:12:21Z","timestamp":1611655941000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Achieving Optimal Medical Therapy: Insights From the ORBITA Trial"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0330-5542","authenticated-orcid":false,"given":"Michael","family":"Foley","sequence":"first","affiliation":[{"name":"National Heart and Lung InstituteImperial College London London UK"},{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher A.","family":"Rajkumar","sequence":"additional","affiliation":[{"name":"National Heart and Lung InstituteImperial College London London UK"},{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Shun\u2010Shin","sequence":"additional","affiliation":[{"name":"National Heart and Lung InstituteImperial College London London UK"},{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7503-7527","authenticated-orcid":false,"given":"Sashiananthan","family":"Ganesananthan","sequence":"additional","affiliation":[{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4244-860X","authenticated-orcid":false,"given":"Henry","family":"Seligman","sequence":"additional","affiliation":[{"name":"National Heart and Lung InstituteImperial College London London UK"},{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Howard","sequence":"additional","affiliation":[{"name":"National Heart and Lung InstituteImperial College London London UK"},{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra N.","family":"Nowbar","sequence":"additional","affiliation":[{"name":"National Heart and Lung InstituteImperial College London London UK"},{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8695-7994","authenticated-orcid":false,"given":"Thomas R.","family":"Keeble","sequence":"additional","affiliation":[{"name":"Essex Cardiothoracic Centre Basildon UK"},{"name":"Anglia Ruskin School of Medicine Chelmsford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John R.","family":"Davies","sequence":"additional","affiliation":[{"name":"Essex Cardiothoracic Centre Basildon UK"},{"name":"Anglia Ruskin School of Medicine Chelmsford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kare H.","family":"Tang","sequence":"additional","affiliation":[{"name":"Essex Cardiothoracic Centre Basildon UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Gerber","sequence":"additional","affiliation":[{"name":"East Sussex Healthcare NHS Trust Hastings UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"O\u2019Kane","sequence":"additional","affiliation":[{"name":"Royal Bournemouth and Christchurch NHS Trust Bournemouth UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew S. P.","family":"Sharp","sequence":"additional","affiliation":[{"name":"University Hospital of Wales Cardiff UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo","family":"Petraco","sequence":"additional","affiliation":[{"name":"National Heart and Lung InstituteImperial College London London UK"},{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iqbal S.","family":"Malik","sequence":"additional","affiliation":[{"name":"National Heart and Lung InstituteImperial College London London UK"},{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sukhjinder","family":"Nijjer","sequence":"additional","affiliation":[{"name":"National Heart and Lung InstituteImperial College London London UK"},{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sayan","family":"Sen","sequence":"additional","affiliation":[{"name":"National Heart and Lung InstituteImperial College London London UK"},{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darrel P.","family":"Francis","sequence":"additional","affiliation":[{"name":"National Heart and Lung InstituteImperial College London London UK"},{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3752-5532","authenticated-orcid":false,"given":"Rasha","family":"Al\u2010Lamee","sequence":"additional","affiliation":[{"name":"National Heart and Lung InstituteImperial College London London UK"},{"name":"Imperial College Healthcare NHS Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.119.006265"},{"key":"e_1_3_2_3_2","first-page":"1383","article-title":"Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S)","volume":"344","year":"1994","unstructured":"Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). 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