An antianginal is a drug used in the treatment of angina pectoris, a symptom of ischaemic heart disease.
Myocardial ischemia arises from the dysfunction of coronary macrovascular or microvascular components, leading to a compromised supply of oxygen and nutrients to the myocardium. The underlying pathophysiological mechanisms encompass a range of factors, including atherosclerosis in epicardial coronary arteries, vasospasm in large or small vessels, and microvascular dysfunction—whose clinical significance is increasingly acknowledged. The diverse clinical presentations of myocardial ischemia collectively fall under the term chronic coronary syndromes.
Addressing these conditions involves a multifaceted approach, where the most common antianginal medications alleviate symptoms by inducing coronary vasodilation and modifying the determinants of myocardial oxygen consumption, such as heart rate, myocardial wall stress, and ventricular contractility. Additionally, these medications can alter cardiac substrate metabolism to alleviate ischemia by enhancing the efficiency of myocardial oxygen utilization. While there is consensus on the prognostic importance of lifestyle interventions and preventive measures like aspirin and statin therapy, determining the optimal antianginal treatment for chronic coronary syndrome patients remains less defined.
The majority of individuals experiencing stable angina can effectively address their condition through lifestyle modifications, particularly by embracing smoking cessation and incorporating regular exercise into their routine. Alongside these lifestyle changes, the use of antianginal drugs is a common approach. However, findings from randomized controlled trials reveal that the efficacy of various antianginal drugs is comparable, with none demonstrating a significant reduction in mortality or the risk of myocardial infarction (MI). Despite this, prevailing guidelines lean towards recommending beta-blockers and calcium channel blockers as the preferred first-line treatment.
The European Society of Cardiology (ESC) guidelines for managing stable coronary artery disease provide well-defined classes of recommendation with corresponding levels of evidence. In a parallel vein, the National Institute for Health and Care Excellence (NICE) guidelines for stable angina management consider cost-effectiveness in their recommendations, designating terms such as first-line and second-line therapy. Notably, both sets of guidelines advocate for the use of low-dose aspirin and statins as disease-modifying agents.
This article aims to critically examine and evaluate the pharmacological recommendations outlined in these guidelines for the management of patients with stable angina. By delving into the nuances of these recommendations, we seek to provide a comprehensive understanding of the rationale behind the suggested pharmacological interventions for stable angina, shedding light on their respective strengths and considerations in clinical practice.[1]
An antianginal is a drug used in the treatment of angina pectoris, a symptom of ischaemic heart disease. Myocardial ischemia arises from the dysfunction...
and marketed by Laboratoires Servier (France). It is an anti-ischemic (antianginal) metabolic agent of the fatty acid oxidation inhibitor class, meaning...
used as antianginal drugs]. In the case of Fenoverine, the relaxation occurs in abdominal / intestinal smooth muscles, while in case of antianginal drugs...
Chirkov SN, Ermakovich II (1996). "A comparative evaluation of the antianginal action of commercially and noncommercially produced validol in neurocirculatory...
an alkyl nitrite. Like amyl nitrite and butyl nitrite, it acts as an antianginal due to vasodilation. The compound is colorless, volatile liquid. Inhaling...
blockers and calcium channel blockers, which are two commonly prescribed antianginal classes of cardiac drugs. Ivabradine has no apparent inotropic properties...
Poppers (or popper) is a slang term referring to recreational drugs belonging to the alkyl nitrite family of chemical compounds. When fumes from these...
dihydropyridine group of calcium channel blocker used as an antihypertensive and antianginal agent. It was approved by the U.S. FDA in December 2019 and is currently...
Perhexiline (Pexsig) is a prophylactic antianginal agent used primarily in Australia and New Zealand. Perhexiline is thought to act by inhibiting mitochondrial...
The WHO Model List of Essential Medicines (aka Essential Medicines List or EML), published by the World Health Organization (WHO), contains the medications...
"Subendocardial Distribution of Coronary Blood Flow and the Effect of Antianginal Drugs". Circulation Research. 1 (6). doi:10.1161/01.res.30.6.621 – via...
Isosorbide is a bicyclic chemical compound from the group of diols and the oxygen-containing heterocycles, containing two fused furan rings. The starting...
do cross the blood–brain barrier, e.g. propranolol).[citation needed] Antianginal effects result from negative chronotropic and inotropic effects, which...
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