Experimental and early investigational drugs for angina pectoris

ABSTRACT

Introduction: Ischemic heart disease (IHD) is a major cause of death and disability among Western countries and angina pectoris is the most prevalent symptomatic manifestation. Strategies to improve management of chronic stable angina are a priority.

Areas covered: A comprehensive review was conducted using the Medline and Cochrane databases as well as the clinical trial databases in the United States and Europe. Traditional therapies for angina will be discussed. This review particularly emphasizes investigational therapies for angina (including pharmacological agents, cell and gene based therapies, and herbal medications).

Expert opinion: There has been renewed interest in older anti-angina agents (e.g., perhexiline, amiodarone, and phosphodiestrase-5 inhibitors). Other anti-inflammatory agents (e.g., allopurinol and febuxostat) are currently undergoing evaluation for angina therapy. Therapeutic angiogenesis continues to face some challenges. Future trials should evaluate the optimum patient population that would benefit from this form of therapy.

KEYWORDS:

• Angina
• coronary artery disease
• ischemic heart disease
• pharmacology

Article Highlights

• Overview of the pathophysiology of angina

• Overview of traditional therapies for angina including beta-blockers, calcium antagonists, nitrates, and others

• Investigational therapies for angina

• Therapeutic angiogenesis and angina, challenges and future directions

• Herbal medications for angina, an unanswered knowledge gap

This box summarizes key points contained in the article.

Declaration of interest

D. Winchester receives a research grant from Roche Diagnostics and has been reimbursed by Roche Diagnostics for attending an advisory board meeting. C. Pepine has received grant support to the University of Florida from Amgen, Astrazeneca, Bayer Healthcare, Boehringer Ingleheim, Capricor Inc., Cytori Therapeutics, Daiichi Sankyo, Florida Health Equity Research Institute, Gilead Sciences Inc., inVentive Health Clinical LLC, NIH/NHLBI, Pfizer, Sanofi-Aventis and United Therapeutics. C.Pepine has also been a consultant for Amgen, AstraZeneca, Bayer Healthcare, Foundation for the Accreditation of Cellular Therapy, Gilead, Merck SLACK Inc. and holds two patents with the University of Florida. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was partially funded by funding support received by C. Pepine from National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR001427).