Atherosclerosis is the underlying pathology in most patients with stable angina pectoris. Atherosclerosis results in plaque formation in the arterial vessel wall. It is caused by smooth muscle cell proliferation and the accumulation of cholesterol, collagen, elastic fibers and connective tissue. When there is an imbalance between oxygen supply and demand associated with clinical symptoms, angina pectoris may result. However, patients with atherosclerotic occlusion of the coronary arteries may have no symptoms.

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