Contemporary Antianginal Therapy.

Area of Science:

• Cardiology
• Pharmacology
• Internal Medicine

Background:

• Stable angina management varies widely despite available drug classes.
• Coronary microvascular dysfunction (CMD) is increasingly recognized as a key pathophysiologic entity.
• There is a critical need for novel pharmacologic therapies for angina, especially for CMD.

Purpose of the Study:

• To review current angina management strategies, focusing on optimal medical therapy (OMT).
• To highlight emerging therapies and the clinical significance of coronary microvascular dysfunction (CMD).
• To outline established and evolving treatment approaches for chronic stable angina.

Main Methods:

• This is a narrative review synthesizing findings from existing research and key clinical trials.
• It outlines established and evolving treatment approaches for chronic stable angina.
• It discusses advances in invasive coronary function testing for CMD diagnosis.

Main Results:

• Beta-blockers and calcium channel blockers are foundational for symptom management.
• Nitrates, ranolazine, ivabradine, and trimetazidine are options for refractory symptoms.
• Few novel pharmacologic therapies have emerged, and optimal treatment for CMD remains elusive.

Conclusions:

• There is a significant need for innovation in angina pharmacotherapy, particularly for CMD.
• Advances in CMD diagnosis exist, but treatment consensus is lacking.
• Emerging interventional and stem cell strategies show promise for refractory angina.