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Expert consensus document: A 'diamond' approach to personalized treatment of angina.

Ferrari, R; Camici, PG; Crea, F; Danchin, N; Fox, K; Maggioni, AP; Manolis, AJ; Marzilli, M; Rosano, GMC; Lopez-Sendon, JL (2018) Expert consensus document: A 'diamond' approach to personalized treatment of angina. Nat Rev Cardiol, 15 (2). pp. 120-132. ISSN 1759-5010 https://doi.org/10.1038/nrcardio.2017.131
SGUL Authors: Rosano, Giuseppe Massimo Claudio

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Abstract

In clinical guidelines, drugs for symptomatic angina are classified as being first choice (β-blockers, calcium-channel blockers, short-acting nitrates) or second choice (ivabradine, nicorandil, ranolazine, trimetazidine), with the recommendation to reserve second-choice medications for patients who have contraindications to first-choice agents, do not tolerate them, or remain symptomatic. No direct comparisons between first-choice and second-choice treatments have demonstrated the superiority of one group of drugs over the other. Meta-analyses show that all antianginal drugs have similar efficacy in reducing symptoms, but provide no evidence for improvement in survival. The newer, second-choice drugs have more evidence-based clinical data that are more contemporary than is available for traditional first-choice drugs. Considering some drugs, but not others, to be first choice is, therefore, difficult. Moreover, double or triple therapy is often needed to control angina. Patients with angina can have several comorbidities, and symptoms can result from various underlying pathophysiologies. Some agents, in addition to having antianginal effects, have properties that could be useful depending on the comorbidities present and the mechanisms of angina, but the guidelines do not provide recommendations on the optimal combinations of drugs. In this Consensus Statement, we propose an individualized approach to angina treatment, which takes into consideration the patient, their comorbidities, and the underlying mechanism of disease.

Item Type: Article
Additional Information: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Keywords: Angina Pectoris, Cardiology, Cardiovascular Agents, Clinical Decision-Making, Comorbidity, Consensus, Humans, Patient Selection, Patient-Centered Care, Risk Assessment, Risk Factors, Treatment Outcome, Humans, Angina Pectoris, Cardiovascular Agents, Treatment Outcome, Risk Assessment, Risk Factors, Consensus, Cardiology, Comorbidity, Patient Selection, Patient-Centered Care, Clinical Decision-Making, Cardiovascular System & Hematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Nat Rev Cardiol
ISSN: 1759-5010
Language: eng
Dates:
DateEvent
February 2018Published
7 September 2017Published Online
Publisher License: Creative Commons: Attribution 4.0
PubMed ID: 28880025
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111199
Publisher's version: https://doi.org/10.1038/nrcardio.2017.131

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