Consensus on evolving usage of anti-anginals: Benefits beyond anginas

Cardiovascular diseases (CVDs) became the leading cause of mortality in India, at the turn of the century. This transition is largely because of the increase in CVD risk factors in India. Ischaemic heart disease is the leading cause of disease burden in India. Traditional anti-anginal drugs, classified as first line and second line give symptom relief and decreased the frequency of angina, however none prevents myocardial ischemia or death caused by coronary disease in patients being treated specifically for chronic stable angina. The Diamond approach is more acceptable as it provides an individualized approach to angina treatment, which takes into consideration the patient, their comorbidities, and the underlying mechanism of disease. The second line drugs such as nicorandil, ranolazine, trimetazidine are equally effective in relieving symptoms and can be considered as the standard of care. Also, the diagnosis of microvascular coronary dysfunction is a challenge which is most of times the underlying cause of angina. Invasive techniques are required for the diagnosis of microvascular angina or vasospastic angina. Therefore, classical and novel anti-anginal medications such as nicorandil should be carefully selected and customized to individual patients. The purpose of this consensus article is to highlight the clinical perspectives of Indian cardiologists at identifying and addressing the need gaps currently existing in India for the management of angina patients and the need for the personalized treatment options.