Chronopharmacological aspects for the prevention of acute coronary syndromes

This review discusses the circadian phase dependency in the anti-anginal effects and in the pharmacokinetics of drugs used in the treatment of coronary heart diseased patients. beta-receptor blocking agents seem mainly to reduce ischaemic events during daytime hours and are of therapeutic value in the morning hours which are the hours of high cardiovascular risk. Calcium channel blockers seem to be less effective in reducing ischaemic event during the night and early morning. However, the galenic formulation and the type of calcium channel blocker may play an important role. Whereas the effects of the anti-ischaemic properties of oral nitrates are well established, their influence of the circadian organization of cardiovascular events needs to be clarified. Only limited data are available concerning the circadian phase dependency in the dose-response relationship of anti-anginal drugs. Such data would be valuable for a better understanding of the need of a time-specified drug treatment which is based on the circadian phase dependency of cardiovascular events such as coronary infarction and angina pectoris attacks.