Trials and tribulations associated with angina and traditional therapeutic approaches

Abstract

SummaryIschemic heart disease is the foremost cause of death in the United States and the developed countries. Stable angina is the initial manifestation of ischemic heart disease in one half of the patients and becomes a recurrent symptom in survivors of myocardial infarction (MI) and other forms of acute coronary syndromes (ACS). There are multiple therapeutic modalities currently available for treatment of anginal symptoms in patients with stable CAD. These include anti-anginal drugs and myocardial revascularization procedures such as coronary artery bypass graft surgery (CABGS), percutaneous transluminal coronary angioplasty (PTCA) and percutaneous coronary intervention (PCI). Anti-anginal drug therapy is based on treatment with nitrates, beta blockers, and calcium channel blockers. A newly approved antianginal drug, ranolazine, is undergoing phase III evaluation. Not infrequently, combination therapy is often necessary for adequate symptom control in some patients with stable angina. Howerever, there has not been a systematic evaluation of individual or combination antianginal grug therapy on hard clinical end points in patients with stable angina. Most revascularization trials that have evaluated treatment with CABGS, PTCA, or PCI in patients with chronic CAD and stable angina have not shown significant improvement in survival or decreased incidence of non-fatal MI compared to medical treatment. In the

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The Anti-Ischemic and Anti-Anginal Properties of Statins

“…Advances in the management of CHD have dramatically improved the survival from acute coronary events. Chronic angina is a recurrent symptom most commonly encountered by these patients [ 3 ]. Ironically, as the number of survivors of myocardial infarction (MI) increases, so does the prevalence of chronic angina.…”