Abstract
Objective: This study aims to investigate the impact of cardiovascular medications on the coronary flow reserve (CFR) in patients without obstructive coronary artery disease (CAD).Methods: We searched PubMed, EMBASE, and Cochrane databases from inception to 15 November 2019. Studies were included if they reported CFR from baseline to follow-up after oral drug therapy of patients without obstructive CAD. Data was pooled using random-effects modeling. The primary outcome was change in CFR from baseline to follow-up after oral drug therapy.Results: A total of 46 studies including 845 subjects were included in this study. Relative to baseline, the CFR was improved by angiotensin-converting enzymes (ACEIs), aldosterone receptor antagonists (ARBs) [standard mean difference (SMD): 1.12; 95% CI: 0.77–1.47], and statins treatments (SMD: 0.61; 95%CI: 0.36–0.85). Six to 12 months of calcium channel blocker (CCB) treatments improved CFR (SMD: 1.04; 95% CI: 0.51–1.58). Beta-blocker (SMD: 0.24; 95% CI: −0.39–0.88) and ranolazine treatment (SMD: 0.31; 95% CI: −0.39–1.01) were not associated with improved CFR.Conclusions: Therapy with ACEIs, ARBs, and statins was associated with improved CFR in patients with confirmed or suspicious CMD. CCBs also improved CFR among patients followed for 6–12 months. Beta-blocker and ranolazine had no impact on CFR.
Highlights
Patients with angina symptoms without obstructive coronary artery disease (CAD) have been difficult to diagnose and treat
Five of these studies showed that statins can improve CFR in patients with symptoms of myocardial ischemia (SMD: 0.68; 95% CI: 0.25–1.11, I2 = 78.7%) (Figure 7)
We reviewed 46 studies that assessed CFR improvement in 845 patients without obstructive CAD treated with oral drugs
Summary
Patients with angina symptoms without obstructive coronary artery disease (CAD) have been difficult to diagnose and treat. Up to 50–65% of these patients are considered to have coronary microvascular dysfunction (CMD) [1,2,3,4,5], which is associated with diastolic heart failure [6,7,8]. The antihypertensives are not intended for CMD, the recent studies showed that ACEIs, ARBs, and CCBs are potentially useful for improving CRF. Data on the effectiveness of CMD medications remain scarce. Most studies on this have inconsistent results. Medications including ACEI, statins, and beta-blockers may be used to treat CMD under the current European Society of Cardiology position paper on CMD [17]. Several reviews suggest that exercise, controlling risk factors, and medications such as angiotensin-converting enzyme inhibitors (ACEIs), aldosterone receptor antagonists (ARBs), and statins may be effective first-line treatments, and medications including nicorandil and ranolazine can be effective second-line treatments [8, 14, 18, 19]
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