Advancements in pharmacotherapy for angina

Abstract

Introduction Angina pectoris is the most prevalent symptomatic manifestation of ischemic heart disease, frequently leads to a poor quality of life, and is a major cause of medical resource consumption. Since the early descriptions of nitrite and nitrate in the 19th century, there has been considerable advancement in the pharmacologic management of angina. Areas covered Management of chronic angina is often challenging for clinicians. Despite introduction of several pharmacological agents in last few decades, a significant proportion of patients continue to experience symptoms (i.e., refractory angina) with subsequent disability. For the purpose of this review, we searched PubMed and Cochrane databases from inception to August 2016 for the most clinically relevant publications that guide current practice in angina therapy and its development. In this article, we briefly review the pathophysiology of angina and mechanism-based classification of current therapy. This is followed by evidence-based insight into the traditional and novel pharmacotherapeutic agents, highlighting their clinical usefulness. Expert opinion Considering the wide array of available therapies with different mechanism efficacy and limiting factors, a personalized approach is essential, particularly for patients with refractory angina. Ongoing research with novel pharmacologic modalities is likely to provide new options for management of angina.

Catastrophic catheter-induced coronary artery vasospasm successfully rescued using intravascular ultrasound imaging guidance

“…The end-product of nitrate metabolism is nitric oxide, which stimulates the enzyme guanylate cyclase to catalyse the production of cyclic guanosine monophosphate. The ultimate effect of nitrates is dependent on their dose: very low doses cause venodilation, low to moderate doses cause arterial dilation and higher doses lead to arteriolar dilation 24. It is noteworthy that simple administration of isosorbide dinitrate was sufficient to resolve the occlusion in our case.…”

A nationwide questionnaire-based survey on practice patterns and management of chronic stable angina with a controlled release formulation of trimetazidine

“…refractory angina) with subsequent disability. 13 In patients with stable CAD, anti-ischemic therapy should fulfill 2 major goals: safely alleviate symptoms, extend exercise duration, improve quality of life, and improve prognosis, prevent cardiovascular events (mainly myocardial infarction and cardiovascular death) by reducing the incidence of acute coronary thrombosis and slowing the progression of coronary atherosclerosis, and delay the development of ventricular dysfunction. 14 Majority of HCPs in our survey still preferred trimetazidine CR 35 mg BD for their angina patients because apart from control of angina attacks, it improves exercise tolerance, quality of life and prevent disease progression.…”