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Intermittent nitrate therapy for prior myocardial infaraction does not induce rebound angina nor reduce cardiac
K Ishikawa1, T Yamamoto, K Kanamasa
1First Department of Medicine, Kinki University School of Medicine, Osakasayama, Osaka.
Insights
Intermittent nitrate administration for ischemic heart disease is safe, as it does not cause rebound angina. This nitrate therapy regimen is a viable alternative to continuous administration for managing heart conditions.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Long-term nitrate therapy for ischemic heart disease can lead to drug tolerance.
- Intermittent nitrate administration is recommended to mitigate tolerance.
- Rebound angina during nitrate-free intervals is a potential concern with intermittent therapy.
Purpose of the Study:
- To investigate the occurrence of rebound angina in patients switched from continuous to intermittent nitrate administration.
- To evaluate the safety and efficacy of intermittent nitrate therapy in patients with prior myocardial infarction.
Main Methods:
- Retrospective study of 606 patients with prior myocardial infarction.
- Comparison of three groups: No-nitrate, Continuous nitrate administration, and Intermittent nitrate administration.
- Mean observation period of 4.3 months.
Main Results:
- No cases of rebound angina were observed in the intermittent nitrate group.
- Cardiac events occurred in 0.3% (No-nitrate), 3.7% (Continuous), and 1.1% (Intermittent) of patients.
- Continuous nitrate administration showed a significantly increased incidence of cardiac events compared to the no-nitrate group.
Conclusions:
- Intermittent nitrate administration is safe and does not induce rebound angina.
- The safety profile of intermittent nitrate therapy is comparable to no nitrate use.
- Further randomized controlled trials are necessary to ascertain the long-term effects on cardiac events.
Objective:
Long-term nitrate therapy for ischemic heart disease may cause drug tolerance which diminishes its beneficial effects; consequently, intermittent administration of nitrates is recommended. With this regimen, however, the potential occurrence of rebound angina during the nitrate-free intervals is a source of concern.
Subjects And Methods:
We carried out a retrospective study of 606 patients to determine whether rebound angina occurred when conventional continuous nitrate administration was replaced by intermittent administration as part of a long-term therapy protocol for prior myocardial infarction. The subjects were receiving treatment for myocardial infarction and included 293 patients treated with nitrates (Nitrate group) and 313 patients who were not (No-nitrate group). The former included 186 patients who received intermittent nitrate administration (Intermittent group) and 107 patients who received continuous administration (Continuous group). The mean period of observation was 4.3 +/- 1.6 months.
Results:
There were no cases of rebound angina in the Intermittent group. Cardiac events occurred in one case in the No-nitrate group (0.3%), in 4 cases in the Continuous group (3.7%) and in 2 cases in the Intermittent group (1.1%). The incidence of cardiac events was thus significantly increased in the Continuous group compared to the No-nitrate group (p < 0.05; odds ratio 9.06; 95% CI 1.41-58.28). The Intermittent group did not significantly differ from the No-nitrate group in the incidence of cardiac events.
Conclusion:
It is concluded that intermittent administration of nitrates does not cause rebound angina and is therefore safe. A randomized controlled trial is needed to find the long-term effect on cardiac events.