Advancements in pharmacotherapy for angina

Abstract

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 19^th 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.

Keywords: Angina; coronary artery disease; ischemia; pharmacotherapy.

Figure 1. Schematic presentation of mechanisms and pathways involved in cardiac chest pain

Ischemic myocardium releases nociceptive mediators that stimulate excitatory spinal and vagal afferent fibers. Somatic fibers also converge on upper thoracic and cervical spinal segments as shown, leading to referred pain. NTS = Nucleus Tractus Solitarius.