Drug Therapy for Stable Angina Pectoris

Abstract

Chronic stable angina pectoris refers to the predictable, reproducible occurrence of pressure or a choking sensation in the chest or adjacent areas caused by myocardial ischemia in association with physical or emotional stress, and cessation of exertion and or sublingual nitroglycerin invariably relieves the discomfort. It is a common presenting symptom of severe narrowing of one or more coronary arteries, non-obstructive coronary arteries, or even when the coronary arteries are angiographically normal. Patients often avoid activities which precipitate symptoms and have impaired quality of life. Most patients with angina pectoris can be managed with lifestyle changes, especially abstinence from smoking and regular exercise, and anti-anginal drugs. However, the choice of initial or combination antianginals as recommended in the guidelines is not evidence based. In addition, patients with stable angina due to coronary artery disease should also receive aspirin and a statin. Treatment of patients with angina and normal coronary arteries remains to be established. The aim of this article is to provide the readers not only with a guideline-based approach, which varies from one country to another, but also an individual-based approach, which takes into consideration circulatory status and the presence or absence of comorbidities in the treatment decision-making process. This manuscript primarily deals with drug therapy of stable angina pectoris and not coronary artery revascularization, which also provides angina relief but is usually reserved for patients who fail to respond to adequate drug therapy.

Organic mononitrites of 1,2-propanediol act as an effective NO-releasing vasodilator in pulmonary hypertension and exhibit no cross-tolerance with nitroglycerin in anesthetized pigs

“… 33 It has been suggested that organic nitrite bioactivation occurs via glutathione transferases. 36 – 38 GTN is a recommended symptomatic therapy for angina pectoris, 17 but tolerance development may be an obstacle to long-term infusions of GTN. In clinical use, it is advantageous to use an NO donor like an organic nitrite lacking tolerance development that also fulfills the summary beneficial effects of GTN in the respective disease condition.…”

“… 16 Despite tolerance development, organic nitrates – particularly GTN – are effective and recommended antianginal medications. 17 Certain NO donors, notably organic nitrites, seem to provoke less development of tolerance possibly due to a better maintained NO generation during infusions in vivo. 18 – 20 Recently, we synthesized novel NO donors for IV infusion, the organic mononitrites of 1,2-propanediol (PDNO, Figure 1 ), which were potent vasodilators, especially in the pulmonary circulation.…”

Treatment of Angina: Where Are We?

“…Therefore, it is likely that the prognosis is better than that reported in published data [34]. However, individual prognoses can vary considerably, depending on baseline clinical, functional, and anatomic characteristics.…”

Modern Drug Therapy of the Chronic Stable Anginae (Review)

“…Выбор конкретного базисного препарата (первой линии) или его комбинаций с другими препаратами (вто-рой линии) следует проводить согласно общепринятым рекомендациям: с учетом индивидуального подхода, тяжести стенокардии, гемодинамических показателей: частоты сердечных сокращений (ЧСС) и артериального давления (АД), наличия коморбидных состояний [1][2][3]. Дополнительно пациентам следует назначать статины и ацетилсалициловую кислоту.…”