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Prognosis of patients with stable angina pectoris on antianginal drug therapy
P Hjemdahl1, S V Eriksson, C Held
1Department of Clinical Pharmacology, Karolinska Hospital, Stockholm, Sweden.
Insights
Beta-1 blockers, verapamil, and slow-release nifedipine may improve prognosis for patients with stable angina pectoris. These antianginal drugs reduce symptoms and ischemia, with beta-1 blockers showing favorable effects on prognosis.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Antianginal drug treatment is crucial for managing stable angina pectoris symptoms and ischemia.
- The impact of these treatments on patient prognosis remains an area of active investigation.
- Previous studies have yielded varied results regarding the long-term benefits of different antianginal medications.
Purpose of the Study:
- To evaluate the influence of antianginal drug treatment on the prognosis of patients with stable angina pectoris.
- To compare the efficacy and safety of atenolol, slow-release nifedipine, metoprolol, and verapamil.
- To assess the impact of these medications on cardiac complications, angina aggravation, and overall patient outcomes.
Main Methods:
- Review and synthesis of data from key clinical trials: ASIST, TIBET, and APSIS.
- Analysis of patient-years of treatment for atenolol, placebo, slow-release nifedipine, metoprolol, and verapamil.
- Examination of subgroup analyses, including hypertensive and diabetic patients, and post-myocardial infarction outcomes.
Main Results:
- Atenolol showed reduced angina aggravation and a trend toward fewer cardiac complications compared to placebo in ASIST.
- TIBET found no significant differences in cardiac complications between slow-release nifedipine, atenolol, or combination therapy, with more side effects from nifedipine alone.
- APSIS demonstrated similar cardiovascular endpoints and tolerability between metoprolol and verapamil; subgroup analyses suggested potential differential effects in hypertensive and diabetic patients.
Conclusions:
- Beta-1 blockers, verapamil, and possibly slow-release nifedipine may favorably influence the prognosis of patients with stable angina pectoris.
- While antianginal drugs alleviate symptoms, conclusive evidence on prognosis is limited by the scarcity of long-term placebo data.
- Current evidence suggests that patients with stable angina pectoris generally fare well with medical management, particularly with beta-1 blockers and verapamil.
Abstract:
Antianginal drug treatment reduces symptoms and ischemia but may also influence the prognosis of patients with stable angina pectoris. The Atenolol Silent Ischemia Study (ASIST) compared atenolol and placebo treatment (about 140 patient-years on each) in patients with mainly silent ischemia and found less aggravation of angina and a tendency toward fewer cardiac complications with atenolol treatment. The Total Ischaemic Burden European Trial (TIBET) compared slow release nifedipine, atenolol, or the combination (about 450 patient-years on each) and found no significant differences with regard to cardiac complications, a nonsignificant trend toward better prognosis on combined treatment, and more side effects on nifedipine alone compared with the other treatments. The Angina Prognosis Study in Stockholm (APSIS) compared metoprolol and verapamil (about 1,400 patient-years on each) and found similar effects on cardiovascular endpoints, tolerability, and psychosocial variables with the 2 treatments. Hypothesis-generating subgroup analyses in APSIS suggest that treatment effects may differ in hypertensive and diabetic subgroups. Beneficial effects in primary and secondary prevention, together with data from ASIST, suggest that beta 1 blockade influences prognosis favorably. The safety of short-acting nifedipine in ischemic heart disease is questioned, but TIBET data suggest that slow release nifedipine may be safe. Verapamil has beneficial effects after myocardial infarction (Danish Verapamil Infarction Trial II) and shows similar efficacy as metoprolol in the APSIS study. The paucity of placebo data (antianginal treatment cannot be withheld during long periods of time in symptomatic patients) precludes firm conclusions regarding effects of drug treatment on prognosis. It is argued that patients with stable angina pectoris do well on medical treatment, and that beta 1 blockers, verapamil, and, possibly, slow-release nifedipine may influence their prognosis favorably.