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Anginal drugs

Olga Gruzdeva, Evgenya Uchasova, Yulia Dyleva, Olga Akbasheva, Victoria Karetnikova, Olga Barbarash
Dyslipidemia is one of the primary causes of cardiovascular disease. Therefore, attention has been focused on the development of drugs that normalize lipid levels and exert an effect on markers of atherothrombosis, insulin resistance (IR), and inflammation. Atorvastatin is a drug with not only lipid-lowering potential, but it has multiple non-lipid effects. This study aimed to evaluate atorvastatin effects on lipid, adipokine, IR, and inflammatory statuses in patients with myocardial infarction (MI) in an in-hospital setting...
2016: Frontiers in Pharmacology
Cher-Rin Chong, Gao J Ong, John D Horowitz
Angina pectoris, or symptomatic myocardial ischaemia, reflects an impairment of coronary blood flow, and usually a deficiency of available myocardial energetics. Treatment options vary with the precise cause, which may vary with regards to the roles of increased myocardial oxygen demand versus reduced supply. Traditionally, organic nitrates, β-adrenoceptor antagonists, and non-dihydropyridine calcium antagonists were the only commonly used prophylactic anti-anginal agents. However, many patients failed to respond adequately to such therapy, and/or were unsuitable for their use...
October 6, 2016: Expert Opinion on Emerging Drugs
Talla A Rousan, Sunil T Mathew, Udho Thadani
INTRODUCTION: Angina pectoris is a common presenting symptom of underlying coronary artery disease or reduced coronary flow reserve. Patients with angina have impaired quality of life; and need to be treated optimally with antianginal drugs to control symptoms and improve exercise performance. A wide range of antianginal medications are approved for the treatment of angina, and often more than one class of antianginal drugs are used to adequately control the symptoms. This expert opinion highlights the likely cardiac adverse effects of available antianginal drugs, and how to minimize these in individual patients and especially during combination treatment...
September 29, 2016: Expert Opinion on Drug Safety
Cian P McCarthy, Kieran V Mullins, David M Kerins
With evidence for efficacy in such diverse clinical settings such as stable coronary artery disease, reperfusion injury, and contrast-induced nephropathy, trimetazidine (TMZ) is novel among cardiovascular agents. In spite of this and almost half a century of clinical experience with the drug, it remains licensed only as an adjunct in the management of angina pectoris in patients who are inadequately controlled by or intolerant to first-line therapies. Although no single pharmacological mechanism has been hitherto universally accepted, TMZ is known to target deranged cellular energetics particularly in ischaemic myocardial tissue...
October 2016: European Heart Journal. Cardiovascular Pharmacotherapy
Alessandra Guidi, Cristiana Lalli, Emerald Perlas, Giulia Bolasco, Martina Nibbio, Edith Monteagudo, Alberto Bresciani, Giovina Ruberti
BACKGROUND: Schistosomiasis, one of the world's greatest human neglected tropical diseases, is caused by parasitic trematodes of the genus Schistosoma. A unique feature of schistosome biology is that the induction of sexual maturation as well as the maintenance of the differentiation status of female reproductive organs and egg production, necessary for both disease transmission and pathogenesis, are strictly dependent on the male. The treatment and most control initiatives of schistosomiasis rely today on the long-term application of a single drug, praziquantel (PZQ), mostly by campaigns of mass drug administration...
August 2016: PLoS Neglected Tropical Diseases
Alessandra Giavarini, Ranil de Silva
Stable angina pectoris affects 2-4 % of the population in Western countries and entails an annual risk of death and nonfatal myocardial infarction of 1-2 % and 3 %, respectively. Heart rate (HR) is linearly related to myocardial oxygen consumption and coronary blood flow, both at rest and during stress. HR reduction is a key target for the prevention of ischemia/angina and is an important mechanism of action of drugs which are recommended as first line therapy for the treatment of angina in clinical guidelines...
August 2016: Cardiovascular Drugs and Therapy
Christopher H George, Alice N Mitchell, Ryan Preece, Mark L Bannister, Zaheer Yousef
INTRODUCTION: The re-purposing of the anti-anginal drug perhexiline (PHX) has resulted in symptomatic improvements in heart failure (HF) patients. The inhibition of carnitine palmitoyltransferase-1 (CPT-1) has been proposed as the primary mechanism underlying the therapeutic benefit of PHX. This hypothesis is contentious. AREAS COVERED: We reviewed the primary literature and patent landscape of PHX from its initial development in the 1960s through to its emergence as a drug beneficial for HF...
September 2016: Expert Opinion on Therapeutic Patents
Giuseppe M C Rosano, Cristiana Vitale, Maurizio Volterrani
Percutaneous coronary intervention and anti-anginal medications have similar prognostic effectiveness in patients with chronic stable angina. The choice of optimal medical therapy for the management of chronic angina is of pivotal importance in patients with stable ischemic heart disease. The most commonly used anti-anginal agents have demonstrated equivalent efficacy in improving patient reported ischemic symptoms and quantitative exercise parameters. With regards to mortality, beta-blockers are beneficial only in the setting of depressed left ventricular systolic function after a recent myocardial infarction...
August 2016: Cardiovascular Drugs and Therapy
Xin Cao, Yuji Nakamura, Takeshi Wada, Hiroko Izumi-Nakaseko, Kentaro Ando, Bingmei Zhu, Bin Xu, Akira Takahara, Masaki Saitoh, Atsushi Sugiyama
We assessed the anti-anginal effects of cilnidipine in comparison with those of nicardipine and nifedipine (1 and 10 µg/kg, n = 6 for each drug) or vehicle (n = 6) by using the vasopressin-induced angina model of rats. The administration of vasopressin (0.5 IU/kg, i.v.) to the rats depressed the S-wave level of the electrocardiogram reflecting the presence of subendocardial ischemia, whereas it significantly increased the mean blood pressure, resulting in the decrease of the heart rate and the prolongation of the PR interval possibly through a reflex-mediated increase in vagal tone...
May 18, 2016: Heart and Vessels
Xiaoqing Guo, Melanie Dumas, Bonnie L Robinson, Syed F Ali, Merle G Paule, Qiang Gu, Jyotshna Kanungo
Verapamil is a Ca(2) (+) channel blocker and is highly prescribed as an anti-anginal, antiarrhythmic and antihypertensive drug. Ketamine, an antagonist of the Ca(2) (+) -permeable N-methyl-d-aspartate-type glutamate receptors, is a pediatric anesthetic. Previously we have shown that acetyl l-carnitine (ALCAR) reverses ketamine-induced attenuation of heart rate and neurotoxicity in zebrafish embryos. Here, we used 48 h post-fertilization zebrafish embryos that were exposed to relevant drugs for 2 or 4 h...
May 18, 2016: Journal of Applied Toxicology: JAT
Cher-Rin Chong, Benedetta Sallustio, John D Horowitz
Approaches to the pharmacotherapy of angina pectoris have previously centred on the concept that a transient imbalance between myocardial oxygen "demand" and supply within the myocardium can best be addressed by reducing demand (for example, with β-adrenoceptor antagonist) or by increasing availability of blood (via coronary vasomotor reactivity adjustment or coronary revascularization). However, this principle is potentially challenged by the emergence of cases of angina unsuitable for such therapies (for example because of concomitant severe systolic heart failure) and by the recognition that impaired myocardial energetics may precipitate angina in the absence of fixed or variable coronary obstruction (for example in hypertrophic cardiomyopathy)...
August 2016: Cardiovascular Drugs and Therapy
Gaetano Antonio Lanza, Filippo Crea
Pharmacologic treatment of myocardial ischemia in patients with chronic stable angina (CSA) is mainly based on heart rate lowering drugs and vasodilator agents. Other drugs are available, however, that act by some peculiar mechanism (ranolazine, trimetazidine) and may add potential anti-ischemic and anti-anginal effects to standard therapeutic mechanisms. While anti-ischemic agents are crucial for controlling angina symptoms and improving quality of life, whether myocardial ischemia portends an ominous prognosis and its suppression improves clinical outcome in CSA patients remain debated issues...
August 2016: Cardiovascular Drugs and Therapy
Jae Chul Lee, Kwan Chang Kim, Soo Young Choe, Young Mi Hong
Pulmonary arterial hypertension (PAH) is a severe pulmonary vascular disease characterized by sustained increase in the pulmonary arterial pressure and excessive thickening and remodeling of the distal small pulmonary arteries. During disease progression, structural remodeling of the right ventricular (RV) impairs pump function, creates pro-arrhythmic substrates and triggers for arrhythmias. Notably, RV failure and lethal arrhythmias are major contributors to cardiac death in PAH that are not directly addressed by currently available therapies...
March 2016: Anatomy & Cell Biology
Zhenling Liu, Ji-Mei Chen, Huanlei Huang, Michelle Kuznicki, Shaoyi Zheng, Wanqing Sun, Nanhu Quan, Lin Wang, Hui Yang, Hui-Ming Guo, Ji Li, Jian Zhuang, Ping Zhu
INTRODUCTION: Trimetazidine (TMZ) is an anti-anginal drug that has been widely used in Europe and Asia. The TMZ can optimize energy metabolism via inhibition of long-chain 3-ketoacyl CoA thiolase (3-KAT) in the heart, with subsequent decrease in fatty acid oxidation and stimulation of glucose oxidation. However, the mechanism by which TMZ aids in cardioprotection against ischemic injury has not been characterized. AMP-activated protein kinase (AMPK) is an energy sensor that controls ATP supply from substrate metabolism and protects heart from energy stress...
March 2016: Metabolism: Clinical and Experimental
Giuseppe Ambrosio, Juan Tamargo, Peter J Grant
Patients with coronary artery disease and concomitant diabetes mellitus tend to have more extensive vessel disease than non-diabetes mellitus coronary artery disease patients, are at high risk of adverse cardiovascular events and suffer from a great anginal burden. Very few trials have specifically addressed the issue of optimal anti-anginal therapy in coronary artery disease patients who also have diabetes mellitus. Among 'classical' anti-anginal agents, recent guidelines do not specifically recommend any molecule over others; however, European Society of Cardiology guidelines acknowledge that favourable data in patients with concomitant diabetes mellitus and coronary artery disease are available for trimetazidine and ranolazine, two anti-anginal agents with a non-haemodynamic mechanism of action...
March 2016: Diabetes & Vascular Disease Research
Umberto Pisano, Jordanna Deosaran, Stephen J Leslie, Gordon F Rushworth, Derek Stewart, Ian Ford, Angus J M Watson
INTRODUCTION: Nicorandil is a popular anti-anginal drug in Europe and Japan. Apart from some common adverse drug reactions (ADR), its safety is satisfactory. Several reports have suggested a link between nicorandil, gastrointestinal (GI) ulceration and fistulas. The review aims to critically appraise, synthesize and present the available evidence of all known GI ADR per anatomical location. METHODS: The study complied with the PRISMA statement. Literature and pharmacovigilance databases were used to provide rate and/or calculate parameters (median age, median dose, history of symptoms, length of therapy and healing time after withdrawal of the drug)...
March 2016: Advances in Therapy
Anvesha Singh, Christopher D Steadman, Jamal N Khan, Giorgio Reggiardo, Gerry P McCann
BACKGROUND: Ranolazine is a new anti-anginal drug that acts via late sodium current inhibition, and has been shown to improve diastolic dysfunction in isolated myocytes. Diastolic dysfuntion is common in patients with aortic stenosis (AS), and precedes symptom development and systolic dysfunction. The purpose of this study was to assess the effects of ranolazine on peak early diastolic strain rate (PEDSR) and exercise capacity in patients with AS. METHODS: Patients with asymptomatic moderate to severe AS and diastolic dysfunction underwent trans-thoracic echocardiography, exercise testing and cardiac magnetic resonance (CMR) imaging at baseline, 6 weeks after commencing ranolazine and at 10 weeks (4 weeks after discontinuation)...
2016: BMC Research Notes
M Cavar, M Ljubkovic, C Bulat, D Bakovic, D Fabijanic, J Kraljevic, N Karanovic, Z Dujic, C J Lavie, U Wisloff, J Marinovic
BACKGROUND AND PURPOSE: Trimetazidine, known as a metabolic modulator, is an anti-anginal drug used for treatment of stable coronary artery disease (CAD). It is proposed to act via modulation of cardiac metabolism, shifting the mitochondrial substrate utilization towards carbohydrates, thus increasing the efficiency of ATP production. This mechanism was recently challenged; however, these studies used indirect approaches and animal models, which made their conclusions questionable. The goal of the current study was to assess the effect of trimetazidine on mitochondrial substrate oxidation directly in left ventricular myocardium from CAD patients...
May 2016: British Journal of Pharmacology
Yihong Sun, Jinming Yu, Dayi Hu
OBJECTIVE: To observe the current status of β-blocker (BB) use and heart rate control in Chinese patients with stable coronary artery disease (SCAD) based on subgroup data of the prospective observational longitudinal registry of patients with stable coronary artery disease (CLARIFY). METHODS: The CLARIFY study is an international prospective observational registry of outpatients with SCAD. From November 2009 to July 2010, patients with SCAD were enrolled, and demographic information, clinical indicators, medication and blood flow reconstruction were collected...
January 2016: Zhonghua Xin Xue Guan Bing za Zhi
Pierre Frange, Albert Faye, Véronique Avettand-Fenoël, Erianna Bellaton, Diane Descamps, Mathieu Angin, Annie David, Sophie Caillat-Zucman, Gilles Peytavin, Catherine Dollfus, Jerome Le Chenadec, Josiane Warszawski, Christine Rouzioux, Asier Sáez-Cirión
BACKGROUND: Durable HIV-1 remission after interruption of combined antiretroviral therapy (ART) has been reported in some adults who started treatment during primary infection; however, whether long-term remission in vertically infected children is possible was unknown. We report a case of a young adult perinatally infected with HIV-1 with viral remission despite long-term treatment interruption. METHODS: The patient was identified in the ANRS EPF-CO10 paediatric cohort among 100 children infected with HIV perinatally who started ART before 6 months of age...
January 2016: Lancet HIV
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