Modern symptomatic therapy for stable angina pectoris: what to choose?

Yu.M. Sirenko, O.O. Torbas


Coronary heart disease is the second most common cardiovascular disease in the world and in Ukraine after hypertension, and therefore, the management of patients with hypertension and сoronary heart disease is a task not only for the cardiologist, but also for the physician at any level of medical care provision. Symptomatic treatment of stable angina, which involves the relief and prevention of the chest pain (or angina equivalents) in patients with сoronary heart disease, remains an actual strategy in cases where angina attacks remain even despite of optimally chosen therapy, revascularization is not possible, and the subsequent titration of the first-line drugs is not possible due to the risk of adverse effects. The leading place among the second-line drugs with anti-ischemic effects, which are used to eliminate angina attacks, belongs to short and prolonged forms of nitrates that provide coronary arterial vasodilatation through the activation of the active component, nitric oxide. A prolonged form of isosorbide dinitrate is prescribed most often to prevent angina attacks. The convenient dosing regimen provides, on the one hand, a prolonged effect and, on the other hand, helps to reduce the risk of tolerance to nitrates. However, in practice we can observe the appearance of such complication as headache. In order to avoid this, the practitioner quite often makes a choice in favor of molsidomine. But it has been shown that the antianginal effect of this drug is much lower than that of prolonged forms of nitrates. In Ukraine, molsidomine is prescribed not in the dose for which the antianginal effect (16 mg) was proved, but in a significantly lower one. It has been shown that linsidomine, molsidomine metabolite, is characterized by a significant toxicity, and therefore, many countries refused using molsidomine. The prescription of prolonged forms of nitrates is the most optimal tactic.


coronary heart disease; stable angina pectoris; symptomatic therapy; nitrates; molsidomine


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