Advances in small-molecule therapy for managing angina pectoris in the elderly

ABSTRACT

Introduction: As our population ages, the prevalence of angina is growing, leading to increased morbidity and decreased quality of life. The management of angina in the elderly is challenging due to drug intolerance and/or drug resistance as well as frailty. Over the past decades, many new therapeutic small molecules have been investigated for the management of angina. Although none of these studies have specifically focused on the therapies for the elderly, they offer promising new avenues for the treatment of angina in the elderly.

Areas covered: Herein, the authors provide a review of the recently published literature on the use of small-molecule therapies for angina management in the elderly and provide a brief overview of these therapies.

Expert opinion: A variety of therapeutic classes of existing and newer small molecules are emerging for the management of angina in the elderly. An individualized approach to the management of angina in this growing population is critical for good outcomes. Many small molecules are in their initial stages of clinical use, and further research should be conducted on their utility, especially in the elderly.

KEYWORDS:

• Angina pectoris
• angina
• chest pain
• elderly

Article highlights

• Angina is a common symptom disproportionately affecting the elderly and women.

• Angina is associated with increased frailty in the elderly population, leading to adverse outcomes.

• Although there are many approved and some emerging small-molecule therapies for the treatment of angina, more are clearly needed.

• Choice of small molecules for the treatment of angina should be personalized.

• Further studies are necessary to better clarify the role of emerging small-molecule therapies in the elderly.

This box summarizes key points contained in the article.

Declaration of interest

C Pepine receives support from the Gatorade Trust through funds distributed by the University of Florida, Department of Medicine; from NIH NCATS—University of Florida Clinical and Translational Science UL1TR001427; and from PCORnet-OneFlorida Clinical Research Consortium CDRN-1501-26692. Dr Pepine reports grant support (significant) from Adelphi Values (Qualitative MVA), Amorcyte (PRESERVE), Athersys (MI-NSTEMI), BioCardia (CardiAMP), Brigham and Women’s Hospital (INVESTED), Capricor (ALLSTAR), Cytori Therapeutics (ATHENA), Duke Univ. (ADAPTABLE), Gilead Sciences Inc. (RWISE, Univ. FL site), Merck & Co. Inc. (VICTORIA), Mesoblast (TEVA, Univ. FL site), NIH/NHLBI (CONCERT), US Dept. of Defense (WARRIOR), Ventrix (CV-201); educational support (modest) for the Vascular Biology Working Group from Amgen Inc., AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Ionis, Relypsa as well as consultant fees/honoraria (modest) from Amgen Inc., AstraZeneca, Bayer Healthcare, Gilead Sciences, Merck and (significant) from Ironwood Pharmaceuticals Inc. and SLACK Inc. He is also a Task force member (no compensation) for the FACT—Foundation for the Accreditation of Cellular Therapy. 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.

Reviewer disclosures

Over the past five years, one referee has served as a consultant for Gilead Sciences, MP4 Pharmaceuticals and The Medicines Company. They have also been on speaker’s programs for Amgen Inc, Gilead Sciences and Daiichi Sankyo/Eli Lilly & Company. Furthermore, they have received research support as a Local PI for multicenter studies from the University of Oklahoma and the VA Medical Center in addition to receiving funds for study support from Gilead Sciences, Bristol-Myers Squibb, Pfizer, AstraZeneca, Sanofi, Johnson and Johnson, Daiichi Sankyo/Eli Lilly and Company. Finally, they have also received funds for study support from the National Institutes of Health and via VA Co-op Studies. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This manuscript was not funded.