The risk of cardiovascular side effects with anti-anginal drugs

ABSTRACT

Introduction: Angina pectoris is a common presenting symptom of underlying coronary artery disease or reduced coronary flow reserve. Patients with angina have impaired quality of life; and need to be treated optimally with antianginal drugs to control symptoms and improve exercise performance. A wide range of antianginal medications are approved for the treatment of angina, and often more than one class of antianginal drugs are used to adequately control the symptoms. This expert opinion highlights the likely cardiac adverse effects of available antianginal drugs, and how to minimize these in individual patients and especially during combination treatment.

Areas covered: All approved antianginal drugs, including the older and newly approved medications with different mechanism of action to the older drugs as well as some of the unapproved herbal medications. The safety profiles and potential cardiac side effects of these medications when used as monotherapy or as combination therapy are discussed and highlighted.

Expert opinion: Because of the different cardiac safety profiles and possible side effects, we recommend selection of initial drug or adjustment of therapy based on the resting heart rate; blood pressure, hemodynamic status; and resting left ventricular function, concomitant medications and any associated comorbidities.

KEYWORDS:

• Angina pectoris
• anti-anginal drugs
• side effects
• safety
• drug interactions

Article highlights

• Cardiovascular effects and adverse safety issues related to anti-anginal drugs.

• Drug-drug interactions.

• Avoidance of nitrates with phosphodiesterase-5-inhibitors.

• Avoidance and/or Careful monitoring for heart rate and evidence of atrioventricular block during combined beta blockers and non-dihydropyridine calcium channel blockers.

• How to use mono- and combination anti-anginal therapy by taking into account hemodynamic effects and cardiovascular safety profile of available drugs.

This box summarizes key points contained in the article.

Declaration of interest

U Thadani has provided consultation services to Clovas Pharmaceuticals and Gilead Sciences and Speaker Bureau for Amgen and Gilead Sciences. He has acted as local PI for NIH and VA Coop. studies and for multicenter trials with Astra Zeneca and Novartis. 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 not funded