Chronic angina pectoris: inadequacies of current therapy

Chronic angina is a major medical problem in the United States with more than 6 million patients affected, a number that will increase substantially because of the progressive aging of the population. The annual mortality rate for patients with chronic angina is approximately 2%, but is much higher in certain subsets of patients, particularly the elderly. Angina is also associated with major social and economic burdens. Because of poor symptom control and hemodynamic, as well as other drug side effects, angina is commonly associated with a poor quality of life. No new class of drug has been available for angina treatment in more than two decades, and current medications frequently fail to provide adequate symptom control. Thus, the majority of patients are taking two or three antianginal medications. New agents that modulate myocardial metabolism have shown antianginal efficacy, a favorable side-effect profile, and an absence of hemodynamic effects.