State of cerebral circulation in neurosensoral deaf in combination stable voltage stenocardia

The aim of this study was to study the state of cerebral circulation using duplex scanning of extra- and intracranial vessels in sensorineural hearing loss in combination with stable exertional angina. The study included 43 patients with diagnosed sensorineural hearing loss in combination with stable exertional angina at the age of 30 to 63 years, who had not previously received antianginal drugs. With the help of color duplex scanning, cerebral circulation in the extra- and intracranial vessels was studied. 19 people (44,2%) had the first degree, and 16 people (37,2%) had the second degree of hearing loss. In 9,3% of cases, the average air conduction rate in patients did not reach 26 dB. In 9,3% of patients, an increase in thresholds was observed only in the ultra-high-frequency zone (10 000–20 000 Hz). In patients with sensorineural hearing loss in combination with stable exertional angina, there was a change in the linear blood flow velocity in the extra- and intracranial vessels. In the common carotid and vertebral arteries, an increase in the linear blood flow velocity and the Gosling pulsative index was revealed. In the intracranial segment, a decrease in the linear velocity of blood flow in the vertebral and main arteries was found, which in 42% of patients was combined with a decrease in the anatomical reserve of blood vessels due to a disconnected variant of the structure of the circle of Willis and / or the presence of obstructed venous outflow.

Why Nicorandil is not Considered to be the First-line Antianginal Drug

According to the results of several short-term randomized controlled trials (RCTs), nicorandil is not inferior in its antianginal efficacy to beta-blockers (BB), calcium channel blockers (CCB) and long-acting nitrates (LAN). At the same time, in some short-term RCTs, as well as in the long-term RCT IONA (2002), it was shown that antianginal efficacy of nicorandil as monotherapy or in combination with other antianginal drugs did not differ from placebo. Ability of nicorandil to reduce the risk of adverse cardiovascular events, demonstrated in the RCT IONA, requires confirmation in a long-term trial with a stronger primary endpoint and concomitant treatment that would meet the current guidelines for the management of patients with chronic coronary syndromes. In this regard, and also taking into account the proven ability of nicorandil to cause gastrointestinal ulcerations, European experts currently consider nicorandil as a drug that is inferior in priority of choice to the first-line antianginal drugs (BB, CCB) and, in some cases, to the second-line drugs (LAN, ivabradine, ranolazine, trimetazidine).

Stable Angina Medical Therapy Management Guidelines: A Critical Review of Guidelines from the European Society of Cardiology and National Institute for Health and Care Excellence

Most patients with stable angina can be managed with lifestyle changes, especially smoking cessation and regular exercise, along with taking antianginal drugs. Randomised controlled trials show that antianginal drugs are equally effective and none of them reduced mortality or the risk of MI, yet guidelines prefer the use of beta-blockers and calcium channel blockers as a first-line treatment. The European Society of Cardiology guidelines for the management of stable coronary artery disease provide classes of recommendation with levels of evidence that are well defined. The National Institute for Health and Care Excellence (NICE) guidelines for the management of stable angina provide guidelines based on cost and effectiveness using the terms first-line and second-line therapy. Both guidelines recommend using low-dose aspirin and statins as disease-modifying agents. The aim of this article is to critically appraise the guidelines’ pharmacological recommendations for managing patients with stable angina.

Withdrawal of prenylamine: perspectives on pharmacological, clinical and regulatory outcomes following the first QT-related casualty

Prenylamine, an antianginal agent marketed since early 1960, became the first casualty of QT interval related proarrhythmias in 1988 when it was withdrawn from the market. The period of its synthesis and marketing is of particular interest since it antedated, first, any serious clinical safety concern regarding drug-induced prolongation of the QT interval which was, in fact, believed to be an efficient antiarrhythmic mechanism; second, the first description of torsade de pointes as a unique proarrhythmia, typically associated with prolonged QT interval; and third, the discovery and recognition of calcium antagonism as an important cardiovascular therapeutic strategy. This review, 30 years almost to the day following its withdrawal, provides interesting perspectives on clinical, pharmacological and regulatory outcomes that followed. Prenylamine underscored torsadogenic potential of other early antianginal drugs on the market at that time and identified QT-related proarrhythmias as a much wider major public health issue of clinical and regulatory concern. This resulted in various guidelines for early identification of this potentially fatal risk. Application of these guidelines would have readily identified its proarrhythmic potential. Prenylamine also emphasized differences in drug responses between men and women which subsequently galvanized extensive research into sex-related differences in pharmacology. More importantly, however, investigations into the mechanisms of its action paved the way to developing modern safe and effective calcium antagonists that are so widely used today in cardiovascular pharmacotherapy.