Relieve heartache in angina pectoris
Over five million people in Germany suffer from coronary heart disease (CHD). With CAD, the coronary arteries constrict and thus circulatory disorders occur, which means that the heart muscle is no longer adequately supplied with oxygen. In those affected, this manifests itself through a feeling of tightness in the chest as well as burning pain, which occurs especially when exercising. A German research team has now summarized treatment options with which the heartache can be alleviated.
A working group from Würzburg, Essen and Mainz compiled the current forms of treatment for angina pectoris. According to the researchers, there is no drug that can prolong the life of people with chronic coronary syndrome, but the heartache associated with the disease can be alleviated. The results were recently presented in the renowned journal “Nature Reviews”.
Treatment compass for angina pectoris
Based on the latest findings, a team of cardiologists created a compass for therapies for angina pectoris, which should serve as a decision-making aid for doctors. The overview is intended to help you use the right combination of drugs at the right time.
No “good” or “bad” for available drugs
First of all, the team has bad news for those with coronary artery disease: Although the range of pharmaceutical treatment options for angina pectoris is growing, there is currently no drug that can prolong the patient’s life. In addition, there is no drug that stands out over others. Whether a drug can improve the quality of life of those affected depends on how well the drug suits the person concerned. The compass is intended to make it easier to decide which medication is best for which person.
Classic drugs for chest pain
The classic drugs for chest pain are therefore beta blockers, calcium channel blockers and nitrates. “They reduce the heart’s consumption of oxygen, expand the blood vessels and thus improve blood flow to the heart muscle,” explains the working group.
The new generation of drugs
According to the researchers, the new generation of drugs includes active ingredients such as ranolazine, trimetazidine and ivabradine. While ivabradine slows the heart rate, ranolazine and trimetazidine intervene in the heart’s metabolism.
Those affected benefit from personalized medicine
As the research group emphasizes, there is so far no evidence that a currently available drug improves the prognosis of CHD. There would be a lack of major studies with the classic drugs, with the new active ingredients, major research work showed no evidence for the prolongation of life.
The bottom line is that no drug is significantly better than another. “Unless you take the cause of the disease and the pathophysiology of each individual patient as the basis for making decisions about treatment,” explains Christoph Maack, Head of Translational Research at the German Center for Heart Failure Würzburg (DZHI).
Blood pressure and heart rate as a basis for decision-making
Important parameters when choosing the right medication are the patient’s blood pressure and heart rate. According to Maack, the combination of these values is particularly decisive: “If the blood pressure is higher than 140 to 80 mmHg and the heart rate is over 70 beats per minute, beta blockers and nitrates are recommended, for example, if the cardiac output is reduced, ivabradine can also be given in addition to beta blockers , calcium channel blockers are advisable if the sputum remains.
Exploiting the heart’s metabolism
As the research group points out, the heart metabolizes 70 to 80 percent of the ingested fatty acids and 10 to 20 percent of sugar. “When glucose is metabolized, the mitochondria, the power plants of our cells, require less oxygen to generate energy than when processing fatty acids,” the researchers explain.
This can be used to treat heart pain because the “active ingredients ranolazine and trimetazidine block the metabolism of fatty acids”. The heart automatically switches to glucose metabolism.
Ranolazine also reduces the influx of sodium into the cells, which in turn has a beneficial effect on the calcium balance. As a result, the heart muscle relaxes due to the reduction in calcium and blood flow improves.
Medicines for people with diabetes
The administration of ranolazine is particularly effective in people with diabetes, as the improved uptake of sugar in the cells simultaneously decreases the blood sugar level. According to the working group, statins are also recommended for diabetics with CHD, as this group of people has a higher risk of events such as heart attacks.
“The statins lower cholesterol, stabilize the inner layer of the blood vessels and thus protect against a heart attack, which is often caused by acute rupture of the inner layer of the blood vessels,” explains the study team.
The researchers also point to the positive and well-documented effects of a healthy lifestyle. Are the cornerstones of this
- Abstaining from nicotine,
- healthy eating,
- regular exercise,
- achieving and maintaining a normal body weight.
How useful are catheters and stents?
As part of the study, the research team also assessed whether dilating a narrowed coronary artery with a catheter or implanting a stent is advisable. According to the researchers, this should be made dependent on the situation of those affected. “In the case of CHD in a stable situation, catheter treatment usually improves the symptoms, but also does not prolong survival,” emphasizes Maack. A personalized medication plan can often be a sensible alternative to the catheter.
“A little stress can also be good for the heart”
Because the drugs help the heart muscle to bypass the bottlenecks. “A little stress can also be good for the heart,” explains Maack. A mechanism comes into play here that is referred to in medicine as preconditioning. “The heart activates molecular self-protection mechanisms and optimizes its metabolism so that it becomes more resistant to a lack of oxygen,” explains the head of the study. (vb)
Author and source information
This text complies with the requirements of specialist medical literature, medical guidelines and current studies and has been checked by medical professionals.
Diploma-Editor (FH) Volker Blasek
- University Hospital Würzburg: What helps against heartache? (published: 07/15/2021), ukw.de
- Edoardo Bertero, Gerd Heusch, Thomas Münzel, Christoph Maack. A pathophysiological compass to personalize antianginal drug treatment; in: Nat Rev Cardiol (2021)., nature.com
This article is for general guidance only and is not intended to be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.