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Emerging options in the management of myocardial ischemia
1Division of Cardiology, University of Florida College of Medicine, Gainesville.
Insights
Understanding myocardial ischemia has improved treatment. New therapies like calcium antagonists, including amlodipine, effectively manage angina and hypertension, offering well-tolerated options for patients with coronary artery disease.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Advances in understanding myocardial ischemia pathogenesis have improved prevention and treatment.
- Platelet function and thrombosis are key in acute myocardial ischemia, leading to aspirin and thrombolytic use.
- Nitrates and beta-blockers alleviate ischemia but have limitations like tolerance and side effects.
Purpose of the Study:
- To review the role of calcium antagonists in managing myocardial ischemia and angina.
- To highlight the efficacy and tolerability of amlodipine as an antianginal agent.
- To discuss the use of calcium antagonists in patients with comorbid conditions like diabetes and hypertension.
Main Methods:
- Review of current literature on myocardial ischemia and its treatment.
- Analysis of the mechanisms of action and clinical applications of calcium antagonists.
- Evaluation of amlodipine's efficacy, tolerability, and dosing advantages.
Main Results:
- Calcium antagonists are effective for stable and vasospastic angina, reducing episodes.
- Amlodipine demonstrates efficacy and good tolerability as a once-daily antianginal therapy.
- Calcium antagonists are well-tolerated in patients with diabetes and hypertension.
Conclusions:
- Calcium antagonists represent a valuable therapeutic class for myocardial ischemia and angina.
- Amlodipine offers a favorable profile for managing angina, particularly with its convenient dosing.
- These agents are suitable for patients with common comorbidities, improving cardiovascular outcomes.
Abstract:
Improved understanding of the pathogenesis of symptomatic and silent myocardial ischemia has led to important advances in the prevention and treatment of these syndromes. For example, recognition of the role of platelets in the atherogenic process and of thrombosis in acute myocardial ischemia has led to extensive use of aspirin and thrombolytic therapy, with resultant decreases in mortality. Both nitrates and beta-adrenergic blockers effectively alleviate myocardial ischemia. However, long-term nitrate use is limited by the occurrence of tolerance. beta blockers have been shown to decrease subsequent cardiovascular events in patients with acute myocardial infarction; however, adverse effects are often associated with their use. Calcium antagonists have been shown to be effective in the treatment of stable and vasospastic angina. In patients with coronary artery disease and symptoms resulting from either fixed obstruction or vasospasm, these agents decrease the frequency of angina episodes. The 3 types of calcium antagonists currently available--phenylalkylamine, benzothiazepine, and dihydropyridine derivatives--while chemically a heterogeneous group, share the common property of decreasing depolarization of smooth muscle, albeit to varying degrees. Nonetheless, other characteristics, including varying electrophysiologic effects, distinguish these groups. The novel calcium antagonist amlodipine is effective and well tolerated as an antianginal agent, and offers the advantage of once-daily dosing. Calcium antagonists appear to be well tolerated in patients with concomitant conditions such as diabetes and are effective in commonly coexistent cardiovascular disorders such as hypertension.