TY - JOUR
T1 - Poor tolerance and limited effects of isosorbide-5-mononitrate in microvascular angina
AU - Wu, Monica
AU - Villano, Angelo
AU - Russo, Giulio
AU - Di Franco, Antonino
AU - Stazi, Alessandra
AU - Lauria, Christian
AU - Sestito, Alfonso
AU - Lanza, Gaetano Antonio
AU - Crea, Filippo
PY - 2015
Y1 - 2015
N2 - OBJECTIVES:
To assess the effects of isosorbide-5-mononitrate (ISMN) in patients with microvascular angina (MVA).
METHODS:
We randomized 20 MVA patients, treated with a β-blocker or a calcium antagonist, to 60 mg slow-release ISMN (halved to 30 mg if not tolerated) or placebo once a day for 4 weeks; the patients were then switched to the other treatment for another 4 weeks. Their clinical status was assessed with the Seattle Angina Questionnaire (SAQ) and the EuroQoL score for quality of life. The exercise stress test (EST), coronary blood flow (CBF) response to nitrate and the cold pressor test (CPT), brachial artery flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) were also assessed.
RESULTS:
Nine patients (45%) did not complete the ISMN phase due to side effects; 2 patients refused a follow-up. Nine patients completed the study. The SAQ and EuroQoL scores were significantly better with ISMN than with placebo, although the differences were small. No differences were found between the treatments in the EST results, CBF response to nitroglycerin (p = 0.55) and the CPT (p = 0.54), FMD (p = 0.26) and NMD (p = 0.35).
CONCLUSIONS:
In this study, a high proportion of MVA patients showed an intolerance to ISMN; in those tolerating the drug, significant effects on their angina status were observed, but the benefit appeared to be modest and independent of effects on coronary microvascular function.
AB - OBJECTIVES:
To assess the effects of isosorbide-5-mononitrate (ISMN) in patients with microvascular angina (MVA).
METHODS:
We randomized 20 MVA patients, treated with a β-blocker or a calcium antagonist, to 60 mg slow-release ISMN (halved to 30 mg if not tolerated) or placebo once a day for 4 weeks; the patients were then switched to the other treatment for another 4 weeks. Their clinical status was assessed with the Seattle Angina Questionnaire (SAQ) and the EuroQoL score for quality of life. The exercise stress test (EST), coronary blood flow (CBF) response to nitrate and the cold pressor test (CPT), brachial artery flow-mediated dilation (FMD) and nitrate-mediated dilation (NMD) were also assessed.
RESULTS:
Nine patients (45%) did not complete the ISMN phase due to side effects; 2 patients refused a follow-up. Nine patients completed the study. The SAQ and EuroQoL scores were significantly better with ISMN than with placebo, although the differences were small. No differences were found between the treatments in the EST results, CBF response to nitroglycerin (p = 0.55) and the CPT (p = 0.54), FMD (p = 0.26) and NMD (p = 0.35).
CONCLUSIONS:
In this study, a high proportion of MVA patients showed an intolerance to ISMN; in those tolerating the drug, significant effects on their angina status were observed, but the benefit appeared to be modest and independent of effects on coronary microvascular function.
KW - isosorbide-5-mononitrate
KW - microvascular angina
KW - isosorbide-5-mononitrate
KW - microvascular angina
UR - http://hdl.handle.net/10807/66119
U2 - 10.1159/000370027
DO - 10.1159/000370027
M3 - Article
SN - 0008-6312
VL - 130
SP - 201
EP - 206
JO - Cardiology
JF - Cardiology
ER -