Expert consensus document: A 'diamond' approach to personalized treatment of angina

Filippo Crea, Roberto Ferrari, Paolo G. Camici, Nicolas Danchin, Kim Fox, Aldo P. Maggioni, Athanasios J. Manolis, Mario Marzilli, Giuseppe M.C. Rosano, José L. Lopez-Sendon

Risultato della ricerca: Contributo in rivistaArticolo in rivista

50 Citazioni (Scopus)

Abstract

In clinical guidelines, drugs for symptomatic angina are classified as being first choice (β-blockers, calcium-channel blockers, short-acting nitrates) or second choice (ivabradine, nicorandil, ranolazine, trimetazidine), with the recommendation to reserve second-choice medications for patients who have contraindications to first-choice agents, do not tolerate them, or remain symptomatic. No direct comparisons between first-choice and second-choice treatments have demonstrated the superiority of one group of drugs over the other. Meta-analyses show that all antianginal drugs have similar efficacy in reducing symptoms, but provide no evidence for improvement in survival. The newer, second-choice drugs have more evidence-based clinical data that are more contemporary than is available for traditional first-choice drugs. Considering some drugs, but not others, to be first choice is, therefore, difficult. Moreover, double or triple therapy is often needed to control angina. Patients with angina can have several comorbidities, and symptoms can result from various underlying pathophysiologies. Some agents, in addition to having antianginal effects, have properties that could be useful depending on the comorbidities present and the mechanisms of angina, but the guidelines do not provide recommendations on the optimal combinations of drugs. In this Consensus Statement, we propose an individualized approach to angina treatment, which takes into consideration the patient, their comorbidities, and the underlying mechanism of disease.
Lingua originaleEnglish
pagine (da-a)120-132
Numero di pagine13
RivistaNATURE REVIEWS. CARDIOLOGY
Volume15
DOI
Stato di pubblicazionePubblicato - 2018

Keywords

  • Cardiology and Cardiovascular Medicine

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