Key result
Newer anti-anginal treatments like ranolazine and ivabradine are expected to play an increasing role in managing chronic stable angina, especially in older patients with co-morbidities.
Highlights significant gaps in guideline-directed medical therapy for chronic stable angina and the need for updated guidelines incorporating newer treatments.
May highlight gaps in stable angina guidelines; leaves open incorporation of newer agents pending randomized evidence.
The optimal medical therapy of patients with chronic stable angina is a controversial issue. While the management of stable angina has certainly improved during the last decade, a number of challenges remain. The European Survey showed that up to 30% of patients do not receive antiplatelet drugs, 50% do not receive a beta-blocker, and 25% do not use a lipid-lowering agent Furthermore, guidelines for the management of stable angina are based on therapies that, at variance with other diseases, have not been extensively evaluated in large randomized trials. Also, both American and European guidelines have been published years ago, and therefore do not take into consideration the role of newer treatment options in management algorithms. As a consequence, many patients at greatest risk receive less than optimal treatment nowadays.
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Francesco Pelliccia (2012) conducted an editorial in Chronic stable angina. Newer anti-anginal treatments (ranolazine, ivabradine, nicorandil) vs. Older anti-anginal drugs (beta-blockers, calcium channel blockers) was evaluated. Newer anti-anginal treatments like ranolazine and ivabradine are expected to play an increasing role in managing chronic stable angina, especially in older patients with co-morbidities.
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