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Published on: April 4, 2022
Insights
Nicorandil, a potassium channel activator, offers symptom control for stable angina. New data suggest it may also reduce coronary events, warranting reassessment for angina management.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Stable angina affects 2 million UK individuals, posing high risk for myocardial infarction (MI) and sudden death.
- Conventional management includes nitrates, beta-blockers, aspirin, and statins; alternatives like calcium channel blockers and nitrates are used for intolerance.
- Nicorandil, a potassium channel activator, is licensed for chronic stable angina prevention and treatment.
Purpose of the Study:
- To reassess the role of nicorandil in angina management.
- To evaluate new data on nicorandil's potential to reduce coronary events.
Main Methods:
- Review of existing literature and new data on nicorandil.
- Comparison of nicorandil's efficacy with other anti-anginal drugs.
Main Results:
- Previous review indicated nicorandil's symptom control was comparable to less expensive alternatives.
- Emerging data suggest nicorandil may decrease the frequency of coronary events in stable angina patients.
Conclusions:
- Nicorandil provides effective symptom control for stable angina.
- Emerging evidence supports nicorandil's potential role in reducing coronary events, necessitating a re-evaluation of its clinical utility.
Abstract:
Around 2 million people in the UK have angina pectoris and are therefore at high risk of severe coronary events such as myocardial infarction (MI) or sudden death. Conventional management of patients with stable angina includes glyceryl trinitrate, a beta-blocker, aspirin and a statin, with the aim of controlling symptoms and reducing the risk of a coronary event. For patients unable to tolerate a beta-blocker, the choice is less clear but calcium channel blockers and long-acting nitrates provide effective symptom control. Another option is nicorandil (Ikorel--Rhône-Poulenc Rorer), a potassium channel activator licensed for the "prevention and long term treatment of chronic stable angina pectoris". In our review of nicorandil 8 years ago, we concluded that it provided symptom control that was as good as, but no better than, other less expensive anti-anginal drugs. Since then, new data have suggested that nicorandil might reduce the frequency of coronary events in patients with stable angina. Here, we consider these findings and reassess the place of nicorandil for patients with angina.
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