how do we further reduce angina in patients already treated with a hemodynamic agent? benefits of...
TRANSCRIPT
How do we further reduce angina in patients already treated with a
hemodynamic agent?
Benefits of adding a metabolic agent to other antianginal drugs(-blockers, CCBs, nitrates…)
in the treatment of stable angina
International Journal of Cardiology - 2014
Peng S et al. Int J Cardiol. 2014;177(3):780-785.
Prof Peng meta-analysis
Methodology
13 randomized, controlled, clinical trials gathering 1628 patients
Assessing the efficacy of a metabolic agent in combination with other antianginal drugs (-blockers, CCBs, nitrates…) vs other antianginal drugs in the treatment of stable angina
Treatment duration: 4 to 24 weeks
End points: Clinical and ergometric parameters
Peng S et al. Int J Cardiol. 2014;177(3):780-785.
Prof Peng meta-analysis
ResultsWeekly mean number
of angina attacksWMD (95% CI) Adding a metabolic
agent to other antianginal agents, significantly
Decreases weekly number of angina attacks
Decreases weekly nitrates consumption
P < 0.001- 0.95
Peng S et al. Int J Cardiol. 2014;177(3):780-785.
Prof Peng meta-analysis
Results
weekly mean numberof angina attacks
WMD (95% CI)
TOTAL WORKWMD (95% CI)
P < 0.001 0.82
P < 0.00149.81
EXERCISE DURATION
WMD (95% CI)
Adding a metabolic agent to other antianginal agents, significantly
Increases total work at peak exercise by 0.82 METs
Increases exercise duration at peak exercise by 49.81 seconds
Peng S et al. Int J Cardiol. 2014;177(3):780-785.
Prof Peng meta-analysis
Discussion
According to the authors:
-“A metabolic agent optimizes cardiac metabolism, leading to an increase in the cell’s tolerance to ischemia”
-“A metabolic agent combined with hemodynamic agents offers full additional efficacy while preserving tolerability”
-“In contrast, studies pointed out the absence or little benefit provided by combined hemodynamic agents. This indicates the superiority of a metabolic agent as an adjunct treatment for stable angina pectoris”
Peng S et al. Int J Cardiol. 2014;177(3):780-785.
Prof Peng meta-analysis
Conclusion
This meta-analysis confirms, in a large population, the efficacy of a metabolic agent in reducing angina and improving exercise capacity in angina patients.
Moreover, it illustrates a fully additive efficacy of metabolic agent when combined with hemodynamic agents.
Benefits of metabolic agent appear in the short term and are maintained in the long term.
Peng S et al. Int J Cardiol. 2014;177(3):780-785.