Stable Angina Medical Therapy Management Guidelines: A Critical Review of Guidelines from the European Society of Cardiology and National Institute for Health and Care Excellence

Overview

Journal Eur Cardiol

Specialty Cardiology & Vascular Diseases

Date 2019 May 28

PMID 31131033

Citations 14

Authors

Talla A Rousan

Udho Thadani

Affiliations

Soon will be listed here.

Abstract

Most patients with stable angina can be managed with lifestyle changes, especially smoking cessation and regular exercise, along with taking antianginal drugs. Randomised controlled trials show that antianginal drugs are equally effective and none of them reduced mortality or the risk of MI, yet guidelines prefer the use of beta-blockers and calcium channel blockers as a first-line treatment. The European Society of Cardiology guidelines for the management of stable coronary artery disease provide classes of recommendation with levels of evidence that are well defined. The National Institute for Health and Care Excellence (NICE) guidelines for the management of stable angina provide guidelines based on cost and effectiveness using the terms first-line and second-line therapy. Both guidelines recommend using low-dose aspirin and statins as disease-modifying agents. The aim of this article is to critically appraise the guidelines' pharmacological recommendations for managing patients with stable angina.

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References

. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 1999; 353(9146):9-13. View

Drummond G, Squire I . The Cardiac Insufficiency Bisoprolol Study II. Lancet. 1999; 353(9161):1361. DOI: 10.1016/s0140-6736(05)74356-7. View

Van der Vring J, Daniels M, Holwerda N, Withagen P, Schelling A, Cleophas T . Combination of calcium channel blockers and beta-adrenoceptor blockers for patients with exercise-induced angina pectoris: a double-blind parallel-group comparison of different classes of calcium channel blockers. Netherlands Working Group on.... Br J Clin Pharmacol. 1999; 47(5):493-8. PMC: 2014186. DOI: 10.1046/j.1365-2125.1999.00924.x. View

Heidenreich P, McDonald K, Hastie T, Fadel B, Hagan V, Lee B . Meta-analysis of trials comparing beta-blockers, calcium antagonists, and nitrates for stable angina. JAMA. 1999; 281(20):1927-36. DOI: 10.1001/jama.281.20.1927. View

. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999; 353(9169):2001-7. View

Szwed H, Sadowski Z, Elikowski W, Koronkiewicz A, Mamcarz A, Orszulak W . Combination treatment in stable effort angina using trimetazidine and metoprolol: results of a randomized, double-blind, multicentre study (TRIMPOL II). TRIMetazidine in POLand. Eur Heart J. 2001; 22(24):2267-74. DOI: 10.1053/euhj.2001.2896. View

. Effect of nicorandil on coronary events in patients with stable angina: the Impact Of Nicorandil in Angina (IONA) randomised trial. Lancet. 2002; 359(9314):1269-75. DOI: 10.1016/S0140-6736(02)08265-X. View

. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002; 360(9326):7-22. DOI: 10.1016/S0140-6736(02)09327-3. View

Borer J, Fox K, Jaillon P, Lerebours G . Antianginal and antiischemic effects of ivabradine, an I(f) inhibitor, in stable angina: a randomized, double-blind, multicentered, placebo-controlled trial. Circulation. 2003; 107(6):817-23. DOI: 10.1161/01.cir.0000048143.25023.87. View

10.

Juul-Moller S, Edvardsson N, Jahnmatz B, Rosen A, Sorensen S, Omblus R . Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina pectoris. The Swedish Angina Pectoris Aspirin Trial (SAPAT) Group. Lancet. 1992; 340(8833):1421-5. DOI: 10.1016/0140-6736(92)92619-q. View

11.

McMurray J, Ostergren J, Swedberg K, Granger C, Held P, Michelson E . Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet. 2003; 362(9386):767-71. DOI: 10.1016/S0140-6736(03)14283-3. View

12.

Cocco G, Rousseau M, Bouvy T, Cheron P, Williams G, Detry J . Effects of a new metabolic modulator, ranolazine, on exercise tolerance in angina pectoris patients treated with beta-blocker or diltiazem. J Cardiovasc Pharmacol. 1992; 20(1):131-8. View

13.

Pfeffer M, Braunwald E, Moye L, Basta L, Brown Jr E, Cuddy T . Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med. 1992; 327(10):669-77. DOI: 10.1056/NEJM199209033271001. View

14.

Chaitman B, Pepine C, Parker J, Skopal J, Chumakova G, Kuch J . Effects of ranolazine with atenolol, amlodipine, or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina: a randomized controlled trial. JAMA. 2004; 291(3):309-16. DOI: 10.1001/jama.291.3.309. View

15.

Hambrecht R, Walther C, Mobius-Winkler S, Gielen S, Linke A, Conradi K . Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation. 2004; 109(11):1371-8. DOI: 10.1161/01.CIR.0000121360.31954.1F. View

16.

Chaitman B, Skettino S, Parker J, Hanley P, Meluzin J, Kuch J . Anti-ischemic effects and long-term survival during ranolazine monotherapy in patients with chronic severe angina. J Am Coll Cardiol. 2004; 43(8):1375-82. DOI: 10.1016/j.jacc.2003.11.045. View

17.

Critchley J, Unal B . Is smokeless tobacco a risk factor for coronary heart disease? A systematic review of epidemiological studies. Eur J Cardiovasc Prev Rehabil. 2004; 11(2):101-12. DOI: 10.1097/01.hjr.0000114971.39211.d7. View

18.

Opie L . Angina pectoris: the evolution of concepts. J Cardiovasc Pharmacol Ther. 2004; 9 Suppl 1:S3-9. DOI: 10.1177/107424840400900102. View

19.

Thadani U . Current medical management of chronic stable angina. J Cardiovasc Pharmacol Ther. 2004; 9 Suppl 1:S11-29. DOI: 10.1177/107424840400900103. View

20.

LaRosa J, Grundy S, Waters D, Shear C, Barter P, Fruchart J . Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005; 352(14):1425-35. DOI: 10.1056/NEJMoa050461. View