Which antianginal agent class is typically first-line therapy for chronic stable angina?

Beta-blockers are typically the first-line therapy for chronic stable angina due to their effectiveness in reducing cardiac workload and oxygen demand. They work by blocking the effects of adrenaline on the heart, leading to a decrease in heart rate, contractility, and overall myocardial oxygen consumption. This helps alleviate the symptoms of angina by allowing the heart to function more efficiently during times of increased demand.

Additionally, beta-blockers provide protective effects by reducing the frequency of angina attacks and improving exercise tolerance over time. They also have long-term benefits in terms of cardiovascular protection and reduction in mortality for patients with coronary artery disease.

In contrast, while nitrates and calcium channel blockers can be useful for symptom relief and may be prescribed in certain situations, they are not typically the first choice. Nitrates provide quick relief of angina symptoms but do not address the underlying cardiac workload issues long-term. Calcium channel blockers may be used when beta-blockers are contraindicated or not tolerated but are generally considered second-line.

Antiplatelet agents, on the other hand, are essential for secondary prevention of cardiovascular events and protecting against thrombus formation but do not directly relieve angina symptoms. Thus, beta-blockers remain the cornerstone for managing chronic stable angina effectively.