Profile of an ideal antianginal agent
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1Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY.
Insights
Current antianginal agents effectively treat myocardial ischemia but have limitations. New drug development aims for ideal treatments that are safe, effective for both angina and silent ischemia, and maintain physical performance.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary artery disease (CAD) management involves antianginal agents.
- These drugs modulate myocardial oxygen supply and demand.
Purpose of the Study:
- To review current antianginal agents and discuss the need for ideal drug characteristics.
- To highlight the limitations of existing treatments.
Main Methods:
- Review of existing literature on antianginal agents.
- Analysis of drug classes: nitrates, beta-blockers, and calcium channel blockers.
- Discussion of treatment efficacy for symptomatic and asymptomatic myocardial ischemia.
Main Results:
- Nitrates, beta-blockers, and calcium entry blockers are effective for myocardial ischemia.
- Some patients cannot tolerate or use these agents due to side effects or contraindications.
- Existing agents may not be metabolically neutral or preserve physical performance.
Conclusions:
- An ideal antianginal drug should treat both angina and silent ischemia effectively.
- The ideal agent must be free of side effects, maintain physical performance, and be metabolically neutral.
- Ongoing research focuses on developing such ideal antianginal agents.
Abstract:
Many antianginal agents are available for the treatment of coronary artery disease. These agents act by influencing the determinants of myocardial oxygen supply and demand. The 3 main classes of agents are the nitrates, beta-adrenergic blocking agents and the calcium entry blockers. Agents from all 3 classes have shown efficacy in treating both symptomatic and asymptomatic myocardial ischaemia. However, some patients cannot be treated with these agents because of side effects or contraindications. An ideal antianginal drug should effectively treat both angina and silent ischaemia. Additionally, it should be free of side effects, allow for maintenance of physical performance and be metabolically neutral. New agents are being developed which strive for this goal.