Coronary artery disease: treating heart pain with angina pectoris

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Relieving heartache from angina pectoris

More than five million people in Germany suffer from coronary heart disease (CHD). In CHD, the coronary arteries become narrowed, leading to circulatory problems, as a result of which the heart muscle is no longer supplied with sufficient oxygen. This manifests itself in sufferers through a feeling of tightness in the chest as well as burning pain, which occurs primarily during exertion. A German research team has now summarized treatment options that can alleviate heart pain.

A research group from Würzburg, Essen and Mainz compiled the current forms of treatment for angina pectoris. Although, according to the researchers, there is no drug that can prolong the lives of sufferers of chronic coronary syndrome, the heartache associated with the disease can be alleviated. The findings were recently presented in the prestigious journal Nature Reviews.

Treatment compass for angina pectoris

Based on current findings, a team of cardiologists created a compass for therapies for angina pectoris, which is intended to serve as a decision-making aid for physicians. The overview is intended to help use the right combination of drugs at the right time.

No “good” or “bad” in available drugs

First, the team has some bad news for people with coronary artery disease: although the range of pharmaceutical treatment options for angina pectoris is growing, no drug currently exists that can prolong patients’ lives. Moreover, there is no drug that stands out over others, he said. Whether a drug can improve the quality of life of those affected depends on how well the drug fits the individual. The compass is intended to make it easier to decide which drug is best suited to which person.

Classic drugs for chest pain

According to the study, the classic drugs for chest pain are beta blockers, calcium antagonists and nitrates. “They reduce the heart’s oxygen consumption, dilate the vessels and thus improve blood flow to the heart muscle,” the research group explains.

The new generation of drugs

According to the researchers, the new generation of drugs includes active substances such as ranolazine, trimetazidine and ivabradine. While ivabradine slows the heart rate, ranolazine and trimetazidine interfere with the heart’s metabolism.

Patients benefit from personalized medicine

As the research group points out, there is no evidence to date that any currently available drug improves the prognosis of CHD. For the classic drugs, large studies would be lacking, and for the new agents, large research studies showed no evidence of life extension.

The bottom line, he said, is that no drug is significantly better than another. “Unless you take the triggers of the disease and the pathophysiology in each individual patient as the basis for deciding on treatment,” explains Christoph Maack, head of translational research at the German Center for Heart Failure Würzburg (DZHI).

Blood pressure and heart rate as a basis for decision-making

The patient’s blood pressure and heart rate are important parameters for selecting the right drug, he says. Above all, the combination of these values is decisive, according to Maack: “If the blood pressure is higher than 140 at 80 mmHg, and the heart rate is above 70 beats per minute, beta blockers and nitrates, for example, are recommended; in the case of reduced cardiac output, ivabradine can also be given in addition to beta blockers, and calcium antagonists are advisable if sputum is preserved.” In cases of low pulse and blood pressure, he said, the use of ranolazine and trimetazidine is recommended.

Exploiting the heart’s metabolism

As the research group points out, the heart alone metabolizes 70 to 80 percent of ingested fatty acids and ten to 20 percent of sugars. “However, when metabolizing glucose, the mitochondria, the power plants of our cells, require less oxygen for energy production than when processing fatty acids,” the researchers explain.

This could be used to treat heart pain, they say, because the “active ingredients ranolazine and trimetazidine block fatty acid metabolism.” As a result, the heart automatically switches to glucose metabolism.

Ranolazine also reduces the influx of sodium into the cells, which in turn has a favorable effect on calcium balance. As a result, the heart muscle relaxes due to the reduction in calcium, and blood flow improves.

Drugs for people with diabetes

The administration of ranolazine is particularly effective in people with diabetes, they say, because the improved absorption of sugar into the cells simultaneously decreases blood sugar levels. Statins are also recommended for diabetics with CHD, according to the study group, because this group of people is at higher risk for events such as heart attacks.

“Statins lower cholesterol, stabilize the inner layer of blood vessels and thus protect against infarction, which is often caused by acute rupture of the inner layer of blood vessels,” the study team explains.

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