[Transcutaneous application of nitroglycerin and isosorbide dinitrate versus placebo: effect in myocardial ischemia]

Area of Science:

• Cardiology
• Pharmacology

Background:

• Coronary artery disease (CAD) and angina pectoris significantly limit exercise capacity.
• Myocardial ischemia, often induced by physical stress, is a primary concern in CAD management.

Purpose of the Study:

• To evaluate the efficacy of topical nitroglycerin and isosorbide dinitrate ointments in improving exercise tolerance.
• To compare the anti-ischemic effects of these nitrates against a placebo in patients with documented CAD.

Main Methods:

• A randomized study involving 12 patients diagnosed with angina pectoris and CAD.
• Administration of nitroglycerin ointment (30 mg) and isosorbide dinitrate ointment (100 mg) versus placebo.
• Assessment of exercise capacity and electrocardiogram (ECG) changes, specifically ST-segment alterations, during stress testing.

Main Results:

• Both nitroglycerin and isosorbide dinitrate ointments demonstrated a significant increase in exercise capacity compared to placebo.
• No significant difference was observed in the overall beneficial effect between nitroglycerin and isosorbide dinitrate ointments.
• Nitroglycerin ointment reduced exercise-induced ST-segment changes by 65%, while isosorbide dinitrate ointment achieved a 41% reduction, both relative to placebo.

Conclusions:

• Topical nitroglycerin and isosorbide dinitrate are effective in enhancing exercise capacity for patients with coronary artery disease.
• Both nitrate formulations similarly alleviate stress-induced myocardial ischemia at comparable workloads.
• These findings support the use of nitrate ointments as a therapeutic option for managing exercise-induced ischemia in CAD.