Treatment effects on the total ischaemic burden and prognostic implications

Area of Science:

• Cardiology
• Pharmacology

Background:

• Anginal symptoms are unreliable indicators of ischaemic heart disease extent.
• Silent ischaemic episodes significantly increase patient morbidity and mortality.
• Effective ischaemia management necessitates targeting daily patterns of both symptomatic and silent events over 24 hours.

Purpose of the Study:

• To evaluate treatment strategies aimed at eliminating both silent and symptomatic ischaemic episodes over a 24-hour period.
• To assess the efficacy of amlodipine and combination therapy in managing ischaemic heart disease.

Main Methods:

• The Circadian Anti-ischaemia Program in Europe (CAPE) trial investigated amlodipine addition to background therapy.
• The Canadian Amlodipine/Atenolol in Silent Ischaemia Study (CASIS) examined combination therapy with amlodipine and atenolol.

Main Results:

• The CAPE trial demonstrated significant 24-hour improvements in objective and subjective ischaemia measures with amlodipine.
• The CASIS study highlighted the complementary effects of combining amlodipine with atenolol.

Conclusions:

• Treatments targeting 24-hour ischaemia, including amlodipine and combination therapy, show promise.
• Further outcome studies are needed to confirm the prognostic impact of these approaches on ischaemic heart disease patients.