Anginal Attacks Research Articles

Cardiac Magnetic Resonance Imaging Based Ischemic Injury Pattern in Patients with Acute Myocardial Infarction Sensu Left Ventricular Global Systolic Function.

The purpose of the study was to identify factors characterizing a decrease in LV global systolic function in patients with ST-segment elevation myocardial infarction (STEMI) after revascularization using cardiac magnetic resonance imaging (MRI)-based ischemic injury pattern and laboratory parameters sensu left ventricular global systolic function. A total of 109 STEMI patients were examined. The patients underwent contrast-enhanced cardiac MRI with a 1.5 Tesla GE SIGNA Voyager (GE HealthCare, Chicago, IL, USA) on the 7th-10th days from the onset of the disease. According to cardiac MRI analysis, the patients were divided into the following groups with regard to left ventricular ejection fraction (LVEF) values: Group 1-patients with LVEF ≥ 50%; group 2-patients with mildly reduced LVEF 40-49%; group 3-patients with low LVEF < 40%. A predominance of most parameters of the ischemic injury pattern was noted in patients with mildly reduced and low LVEF versus patient group with LVEF ≥ 50%. Some risk factors for a decrease in LVEF < 50% systolic function in STEMI patients after revascularization were revealed: male gender; time from the onset of the anginal attack to revascularization; coronary artery status; several LV parameters; ischemic injury characteristics; natriuretic peptide and troponin I levels.

Compound Danshen Dripping Pills combined with isosorbide mononitrate for angina pectoris: A systematic review and a Meta-analysis

ObjectiveTo evaluate the efficacy of Compound Danshen Dripping Pills (CDDP) combined with isosorbide mononitrate (ISMN) versus ISMN alone for treating angina pectoris in patients. MethodsThe PubMed, Web of Science, Cochrane Library, Embase China National Knowledge Infrastructure, China Biomedical Literature Service System, Chinese Medical Journal Database, and Wan Fang MED databases were searched from inception to November 2022. Randomized controlled trials (RCTs) and cohort studies were included. The primary outcomes were angina symptom and electrocardiography (ECG) efficacy, angina symptom efficacy, and ECG efficacy. The protocol was registered with PROSPERO No. CRD42022314774. ResultsOur study included 7 245 patients with angina (59 RCTs, 11 cohort studies). When ISMN was combined with CDDP, the efficacy of angina symptom and ECG [odds ratio (OR) = 4.824, 95% confidence interval (CI) = 3.636–6.401, P = 0.000], the efficacy of angina symptom (OR = 4.347, 95% CI = 3.635–5.198, P = 0.000), the efficacy of ECG (OR = 3.364, 95% CI = 2.767–4.089, P = 0.000) was better than that of patients treated with ISMN alone. CDDP combined with ISMN was superior to ISMN alone in reducing triglyceride (TG) [mean difference (MD) = −35.176, 95% CI = −37.439 to −32.912, P = 0.000], total cholesterol (TC) (MD = −24.296, 95% CI = −26.429 to −22.163, P = 0.000), the duration of angina attack (MD = −1.991, 95% CI = −2.349 to −1.633, P = 0.000), and the frequency of angina attack [standardized MD (SMD) = −2.840, 95% CI = −3.416 to −2.265, P = 0.000]. There was no increase in adverse events between CDDP combined with ISMN and ISMN alone (OR = 0.513, 95% CI = 0.421–0.626, P = 0.000). ConclusionsCDDP combined with ISMN improved treatment efficacy and was well tolerated. Therefore, this combination could be used as an alternative treatment. However, clinical and patient conditions should be considered.

Clinical, Metabolic and Neurohumoral Effects of L-arginine in Patients with Coronary Heart Disease in Combination with Arterial Hypertension

The objective: to analyze the impact of complex therapy using L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts and folic acid on the functional state of the endothelium, tolerance to physical activity, indicators of oxidative stress, lipid metabolism and clinical status patients with stable angina pectoris of the III functional class (FC) in comorbidity with arterial hypertension (AH) of the II grade, stage 2. Materials and methods. 100 patients with stable angina pectoris III FC and AH II grade, stage 2 aged 55–68 years participated in the study. The patients were divided into two groups: 50 patients of the 1st group received standard therapy – RAAS blocker, amlodipine, bisoprolol, acetylsalicylic acid and atorvastatin; 50 patients of the 2nd group in addition to standard therapy received a multi-component product of complex action, which includes L-arginine, ubiquinone (coenzyme Q10), Lcarnitine, lycopene, a number of plant extracts and folic acid, in a dose of 1 sachet per day. At the beginning and at the end of the study endothelial functions were assessed, daily blood pressure (BP) was monitored, physical exercise testing was performed, the weekly number of angina attacks and nitroglycerin tablet taking were recorded, oxidative status parameters were studied, quality of life was assessed, and the results were statistically processed. Results. The use of complex action preparation, which includes L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts and folic acid, as adjuvant therapy demonstrated a decrease in the level of indicators of lipid peroxidation (LPO) and an increase levels of antioxidant protection parameters. In the patients of the 2nd group a statistically significant positive dynamics of the blood pressure level was found: the median of daily systolic blood pressure (SBP) decreased to 131.78 mm (p&lt;0.01). A significant decrease in median daytime and nighttime SBP and diastolic blood pressure (DBP) was also determined (p&lt;0.01). The use of a multicomponent preparation of complex action led to a significant decreased of total cholesterol (CHL) by 14.5%, TG by 10.37% and low-density lipoprotein cholesterol by 12.5%. There was also an increased level of high-density lipoprotein cholesterol by 6.48% (р&lt;0.05 for all indicators). The patients of the 2nd group demonstrated a significant increase in tolerance to physical excesses: an increase in the double product by 21.4% and the total amount of the done work by 78.4% compared to the initial values (р&lt;0.05 for both indicators). After 2 months of treatment the difference between the groups in terms of the decrease in the weekly number of angina attacks was statistically significant (р&lt;0.05). This positive trend was accompanied by a decrease in the median number of nitroglycerin tablets taken per week in the 2nd group from 5.4 to 3.0 (р&lt;0.05). In the patients of the 2nd group after 2 months of observation a statistically significant improvement in quality of life indicators according to the “Seattle Angina Questionnaire” was determined (р&lt;0.05). Conclusions. Although all study participants received identical standard antihypertensive and lipid-lowering therapy, adjuvant use of a multicomponent complex of L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts, and folic acid for 2 months demonstrated a reduction in the impact of oxidative stress with parallel restoration of antioxidant mechanisms, improvement in vascular reactivity in patients and daily control of blood pressure, contributed to the correction of the lipid profile with increased tolerance to physical exercise and, as a result of the above-mentioned effects, had a significant positive impact on the quality of life of patients.

Health care utilization and the associated costs attributable to cardiovascular disease in Ireland: a cross-sectional study.

Cardiovascular disease (CVD) is the leading cause of mortality and disability globally. We examined healthcare service utilization and costs attributable to CVD in Ireland in the period before the introduction of a major healthcare reform in 2016. Secondary analysis of data from 8113 participants of the first wave of The Irish Longitudinal Study on Ageing. CVD was defined as having a self-reported doctor's diagnosis of myocardial infarction, angina, heart failure, stroke, atrial fibrillation or transient ischaemic attack. Participants self-reported the utilization of healthcare services in the year preceding the interview. Negative binomial regression with average marginal effects (AME) was used to estimate the incremental number of general practitioner (GP) and outpatient department (OPD) visits, accident and emergency department attendances and hospitalisations in population with CVD relative to population without CVD. We calculated the corresponding costs at individual and population levels, by gender and age groups. The prevalence of CVD was 18.2% (95% CI: 17.3, 19.0) Participants with CVD reported higher utilization of all healthcare services. In adjusted models, having CVD was associated with incremental 1.19 (95% CI: 0.99, 1.39) GP and 0.79 (95% CI: 0.65, 0.93) OPD visits. There were twice as many incremental hospitalisations in males with CVD compared to females with CVD (AME (95% CI): 0.20 (0.16, 0.23) vs 0.10 (0.07, 0.14)). The incremental cost of healthcare service use in population with CVD was an estimated €352.2 million (95% CI: €272.8, €431.7), 93% of which was due to use of secondary care services. We identified substantially increased use of healthcare services attributable to CVD in Ireland. Continued efforts aimed at CVD primary prevention and management are required.

Efficacy and safety of tongxinluo capsule for angina pectoris of coronary heart disease: an overview of systematic reviews and meta-analysis.

Tongxinluo capsule (TXLC) is a common drug for treating angina pectoris of coronary heart disease (CHD). In recent years, many systematic reviews (SRs) and meta-analyses (MAs) have reported the efficacy and safety of TXLC for improving angina symptoms in patients with CHD. We aimed to comprehensively evaluate the existing SRs and MAs of TXLC in treating angina pectoris of CHD, summarize the evidence quality, and provide scientific evidence and recommendations. We searched seven databases for relevant SRs/MAs published up to 1 June 2023. Two reviewers independently completed the literature retrieval, screening, and data extraction. We used A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) to evaluate the methodological quality, the Risk of Bias in Systematic Reviews (ROBIS) to assess the risk of bias, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to determine the strength of the evidence. RevMan 5.3 was used to synthesize data. We identified 15 SRs/MAs, including 329 RCTs and 33,417 patients. According to the evaluation results of AMSTAR-2, only one SR was of high methodological quality, the others were very low. ROBIS assessment showed that one SR (6.67%) had a low risk, 3 SRs (20%) had an unclear risk, and 11 SRs (73.33%) had a high risk. We assessed 42 outcomes by the GRADE, 10 (23.81%) for moderate-quality evidence, 17 (40.48%) for low-quality evidence, and 15 (35.71%) for very-low-quality evidence. Mate-analysis showed that TXLC combined with conventional western medications improved electrocardiogram efficacy (RR = 1.38, 95% CI: 1.23-1.43, P < 0.001) and angina efficacy (OR = 3.58, 95% CI: 3.02-4.24, P < 0.001), reduced angina attack frequency (SMD = -0.54, 95% CI: -0.64 to -0.44, P < 0.001) and angina duration (SMD = -0.42, 95% CI: -0.57 to -0.28, P < 0.001), with general heterogeneity. The pooled results showed that TXLC appears to have some efficacy in improving cardiac function and relieving angina symptoms, but there is limited evidence that it improves cardiovascular event rates, hemorheology, lipids, or hs-CRP. In the assessment of drug safety, TXLC was associated with different degrees of adverse drug reactions. Based on the evidence, TXLC may be effective as an adjuvant treatment for angina pectoris of CHD. However, the quality of the evidence is low, and the drug's safety must be carefully interpreted. In future studies, high-quality randomized controlled trials are needed to confirm the effectiveness and safety of TXLC. http://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42022365372).

Clinical comprehensive evaluation of Shexiang Tongxin Dropping Pills

Based on literature and questionnaire research, related evidence and related data on Shexiang Tongxin Dropping Pills were collected in terms of safety, effectiveness, economy, innovation, suitability, and accessibility. In addition, multi-criteria decision analysis(MCDA) model was used to comprehensively evaluate the clinical value of Shexiang Tongxin Dropping Pills. Quality control was carried out strictly based on evidence-based medicine evaluation. Shexiang Tongxin Dropping Pills were recommended for stable fatigue angina of coronary heart disease with Qi deficiency and blood stasis by guidelines and experts. The conventional treatment of western medicine adds Shexiang Tongxin Dropping Pills to reduce the frequency of angina attacks, shorten the duration, improve exercise tolerance, and improve the quality of life and Chinese symptoms, and the effectiveness is rated as grade A. Adverse reactions are mostly general adverse reactions, and no serious adverse reactions have been reported, consistent with the known risks listed in the instruction for adverse events, contraindications, and precautions. The safety is rated as grade A, and the daily cost is 7.74 yuan. The cost-effectiveness shows that it is a treatment regimen with pharmacoeconomic advantages, and the economic performance is rated as grade A. According to specialist research, Shexiang Tongxin Dropping Pills have good clinical innovation and service innovation, and innovation is rated as grade A. There are no special storage conditions, medicinal material ingredients, or other restrictions, and the clinical use meets the specifications of the medication guidelines. The suitability is rated as grade A. The price level, availability, and affordability of drugs are generally good, and the accessibility is rated as grade A. The clinical value of Shexiang Tongxin Dropping Pills is great.

Clinical features of coronary artery disease and 5-year survival of patients after myocardial infarction against the background of depressive disorders

Aim. To assess the features of the clinical picture of coronary artery disease (CAD) and the prognosis of patients with myocardial infarction with depressive disorder (DD).&#x0D; Materials and methods. We examined 101 patients with stable CAD who had myocardial infarction more than six months ago: 67 CAD patients with depression (Group 1) and 34 CAD patients without depression (Group 2). The clinical picture of CAD was assessed by complaints, angina self-monitoring diaries, and exercise tests. The presence and severity of DD was determined using psychometric scales: BDI (Beck Depression Scale), HADS (Hospital Anxiety and Depression Scale) and the opinion of a psychiatrist. Five-year survival information was obtained through telephone interviews with patients and their relatives.&#x0D; Results. In patients with CAD and DD in comparison with patients without DD self-monitoring diaries revealed more frequent angina attacks: 9 [6; 12] vs 6 [4; 7] per week (p=0.0001), the greater need for sublingual nitrates: 2 [0; 9] pills vs 0 [0; 4] pills (p=0.0001). DD significantly reduced exercise tolerance: 370 [250; 450] meters vs 435 [350; 500] meters using the six-minute walk test (p=0.04), according to the results of bicycle ergometry – 50 [25; 75] W vs 75 [50; 75] W (p=0.03). After 5 years of follow-up patients with comorbidities (CAD and DD) had a greater number of deaths: 13 (19.4%) vs 2 (5.9%), respectively, survived – 54 (80.6%) vs 32 (94.1%) (Gehan–Wilcoxon test, p=0.04).&#x0D; Conclusion. The comorbidity CAD and DD leads to a worsening of the clinical course of CAD and prognosis, which actualizes the need for verification of the diagnosis of DD and timely prescription of antidepressant therapy.

Trends in High-Acuity Cardiovascular Events During the COVID-19 Pandemic

This cohort study describes changes in myocardial infarction and stroke hospitalizations as well as congestive heart failure, angina, and transient ischemic attack incidents months before and after March 2020 among insured people in New England.

Quantitative assessment of the association between TNF-α gene polymorphisms and angina risk.

Previous investigations into the correlation between tumor necrosis factor-α (TNF-α) gene polymorphism and susceptibility to angina have produced a range of results. This study aims to clarify the potential significance of TNF-α polymorphism as a contributing factor to the onset of angina. A comprehensive review of all corresponding literature was conducted across several major databases, covering their records from inception through to March 2024. Data were synthesized using meta-analysis techniques. Notable associations were identified in various genetic comparisons: allele contrast (A vs. G: OR=0.77, 95% CI=0.70-0.86, P<0.001), homozygote comparison (AA vs. GG: OR=3.35, 95% CI=2.51-4.48, P<0.001), heterozygote comparison (GA vs. GG: OR=1.69, 95% CI=1.19-2.40, P=0.003), recessive genetic model (AA vs. GG/GA: OR=2.40, 95% CI=1.91-3.03, P<0.001), and dominant genetic model (AA/GA vs. GG: OR=1.84, 95% CI=1.27-2.65, P=0.001). Furthermore, ethnicity-based subgroup analyzes revealed that these associations were especially significant within the Asian population and unstable angina, with all genetic models demonstrating statistical significance (P<0.05). TNF-α gene is significantly associated with an increased risk of angina, particularly among the Asian population and unstable angina. This finding underscores the importance of considering genetic factors in the assessment and management of angina risk.

Efficacy and Safety of Jiuxin Pill in the Treatment of Patients with Stable Angina Pectoris: A Protocol for a Randomized, Double-Blind, Placebo-Controlled, Multicenter Clinical Trial.

Stable angina pectoris (SAP), as a common type of coronary heart disease (CHD), is characterized by transient retrosternal squeezing pain or suffocation induced by exercise, mood swings, or other stress. Most patients with stable angina pectoris do not benefit from interventional therapy and medication, so optimizing treatment plans has important clinical significance. Jiuxin pill is a Chinese patent medicine developed by Huatuo Chinese Medicine Co. Ltd. (Bozhou, China) to relieve the symptoms of stable angina pectoris (SAP). However, there is a lack of evidence support from high-quality clinical studies. In this randomized, double-blind, placebo-controlled, multicenter clinical trial, 170 patients with SAP were recruited from 11 centers in China. The patients were randomized to either the treatment group (Jiuxin pill, 2 pills, bid) or the control group (Jiuxin pill simulant, 2 pills, bid) without changing the original conventional western medicine. The trial was set up with a run-in period of 7 days, a treatment period of 28 ± 2 days, and a follow-up period of 28 ± 2 days. Total exercise time (TED) in the treadmill test and Seattle Angina Questionnaire (SAQ) scores were set as the main efficacy outcomes, and the 1-minute heart rate recovery (HRR1), metabolic equivalents (METs), maximum ST segment depression, Borg perceived exertion after exercise, the average number of angina attacks per week, usage of nitroglycerin, drug withdrawal and reduction rate, information scoring of four diagnostic methods in traditional Chinese medicine and incidence of major adverse cardiovascular events were set as the secondary efficacy outcomes. Adverse events were monitored throughout the trial. In China, the use of Chinese patent medicine in the treatment of stable angina pectoris is more common. This trial evaluated the efficacy and safety of the Jiuxin pill in the treatment of patients with SAP, and the trial results provide high-quality research evidence for its clinical application. This trial has been registered in the China Clinical Trial Registry on 11 June 2022 (Registration No.: ChiCTR2200060780, https://www.chictr.org.cn/showproj.html?proj=172352).

PECULIARITIES OF CARBOHYDRATE METABOLISM INDICATORS, THE FUNCTIONAL STATE OF THE THYROID GLAND IN THE COURSE TREATMENT WITH TELMISARTAN AS PART OF THE COMPLEX THERAPY OF PATIENTS WITH CORONARY ARTERY DISEASE, TYPE 2 DIABETES MELLITUS ON THE BASIS OF METAB

Aim. Is to study the characteristics of carbohydrate metabolism indicators, the functional state of the thyroid gland in the course treatment with Telmisartan as a part of the complex therapy of patients with Coronary Artery Disease, type 2 Diabetes Mellitus on the basis of Metabolic Syndrome.&#x0D; Materials and Methods. Research design. The first stage - formation of groups (the experimental group and the comparison group). The experimental group consisting of 27 patients (13 men and 14 women), taking Telmisartan 80 mg/day as a part of complex therapy (Metformin, Amlodipine, Rosuvastatin, Acetylsalicylic acid, and Nitroglycerin as needed). The comparison group consisting of 24 patients (12 men and 12 women) taking Ramipril, 5 mg/day in addition to the standard therapy, mentioned above. At the second stage, the patients were examined for carbohydrate metabolism and Thyroid-stimulating hormone and free Thyroxine. At the third stage, patients were prescribed the treatment for 1 month. The dose of metformin did not change during the study. Re-examination of hormones and carbohydrate metabolism parameters one month after the start of therapy was carried out at the fourth stage. The control group consisted of 40 practically healthy people (17 men and 23 women). The work involved researching the carbohydrate spectrum parameters as well as the followings hormones: free Thyroxine and Thyroid-stimulating hormone, control of blood pressure parameters. The Patients were examined twice, on the day of admission to inpatient treatment and after 1 month. According to the results of the obtained data, the studied groups were compared with each other, as well as with a group of healthy individuals.&#x0D; Results and Discussion. The study compared the dynamics of blood pressure parameters, indicators of carbohydrate metabolism, Thyroid-stimulating hormone and Free thyroxine in patients with Coronary Artery Disease and compensated type 2 Diabetes Mellitus on the basis of Metabolic Syndrome, depending on their intake of Telmisartan or Ramipril against the background of standard therapy, which included: Metformin, Amlodipine, Acetylsalicylic acid. In the group taking Telmisartan as part of complex treatment, a decrease in clinical manifestations of syntropic pathology was found, and the presence of positive dynamics of diastolic blood pressure indicators was noted even after 1 month of treatment. Patients experienced a decrease in the frequency of angina attacks, reduced shortness of breath, palpitations during exercise, headaches, dizziness, anxiety, improved attention and memory. The results of our study show taking Telmisartan as a part of complex therapy contributed to changes in the parameters of carbohydrate metabolism such as fasting blood glucose, insulin level, HOMA-IR index decreased significantly, which can be explained by a decrease in insulin resistance at addition Telmisartan to the complex treatment. In contrast to the mentioned above parameters, indicators of glycosylated hemoglobin after 1 month treatment did not change significantly, which can be explained by the insufficient duration of treatment. In the patients of the experimental group, it was found that the level of Thyroid-stimulating hormone significantly decreased during treatment with Telmisartan as part of complex therapy, in contrast to the comparison group, taking Ramipril at the same time. The level of free Thyroxine in patients with experimental group increased a month after start of therapy, while it remained unchanged in patients with comparison group.&#x0D; Conclusions. The effectiveness of correction of diastolic blood pressure parameters, the presence of peculiarities of changes in carbohydrate metabolism and thyroid functional state when Telmisartan is used as part of the complex therapy of patients with Coronary Artery Disease and compensated type 2 Diabetes Mellitus on the basis of Metabolic Syndrome. The use of Telmisartan as part of complex treatment reduces insulin resistance; helps to reduce the level of fasting blood glucose, values of the HOMA-IR index, as well as the amount of insulin in the blood. The use of Telmisartan in patients with Coronary Artery Disease and type 2 Diabetes Mellitus on the basis of Metabolic Syndrome aids in reducing the level of Thyroid-stimulating hormone and increase in free Thyroxine (within the reference values), confirming participation in the correction of metabolic changes.

Effectiveness and tolerability of trimetazidine 80mg once daily in patients with chronic coronary syndrome: the V-GOOD observational study

Abstract Background Trimetazidine (TMZ) has shown anti-ischemic and anti-anginal effects by shifting the production of ATP from free fatty acid to glucose oxidation. Few clinical studies have looked at the effectiveness and tolerability of a new presentation of TMZ (80mg once daily) in real-world practice. Purpose The V-GOOD study was conducted in routine clinical practice to evaluate the effect of adding TMZ 80mg OD to treat patients with angina or angina equivalents despite treatment with background anti-anginal therapies. Methods This multicenter, prospective, observational study recruited symptomatic adult outpatients with a confirmed diagnosis of stable angina to whom physicians had decided to prescribe TMZ 80mg OD in 70 health facilities across Brazil from October 2021 to June 2022. Data on the number of angina attacks, the prevalence of angina-free patients, severity of angina (CCS class), impairment in daily activities, treatment adherence, tolerability, and physician and patient satisfaction were collected at baseline (V1) and at 1-month (V2) and 3-month (V3) follow-up visits. Patients with known hypersensitivity to TMZ, Parkinson's disease, related movement disorders, and severe or moderate renal impairment were excluded. Results 1,029 patients (57.9% women) with a mean age of 66.8±10.3 years were included, and 959 (93.2%) completed all three planned visits. Diabetes (53.7%), dyslipidemia (85.1%), and hypertension (85.1%) were the most frequent cardiovascular risk factors; 55.7% of patients had angina CCS class II and 25.1% class III. At V1, the mean number of angina attacks per week was 5.1±3.7 despite anti-anginal therapy, including beta-blockers (82%), CCBs (23%), and nitrates (22%). Following the addition of TMZ 80 OD, it decreased to 3.4±3.3 attacks per week at V2 and 3.5±6.4 at V3 (P&amp;lt;.001). The prevalence of angina-free patients increased from 15.4% (V1) to 73% at V3 (P&amp;lt;.001); accordingly, there was a significant decrease in the proportion of patients with limiting angina (CCS 3 or 4) from 27.3% (V1) to 8.7% (V3) (P&amp;lt;.001). The assessment of impairment in daily activities by a visual scale (ranging from 0 to 10) showed a significant improvement from V1 (5.1±2.2) to V3 (2.1±2.2) (P&amp;lt;.001). Patient adherence to the anti-anginal treatment was excellent, with only 4.4% of patients reporting forgetting to take the drug. The incidence of any adverse event was 2.1% on V3, with 1.1% attributed to the drug. In the end, satisfaction with treatment was classified as satisfactory/very satisfactory by 97.1% of patients and 91.0% of doctors. Conclusion The study confirms that the new formulation of TMZ 80mg OD when added to anti-anginal therapy in patients with symptomatic chronic coronary syndrome effectively reduced the angina frequency and severity, improved functional class, yielded a significant proportion of patients free of angina, decreased physical limitation, and it was well tolerated.

What Is New in the 2023 European Society of Cardiology Guidelines for the Management of Acute Coronary Syndromes

For the first time, European Society of Cardiology (ESC) guidelines have aggregated in 1 single document recommendations for the management of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) and ST-elevation myocardial infarction (STEMI). From a clinical perspective, this is coherent, as the spectrum of clinical presentations in acute coronary syndromes (ACS) may range from new onset or progressive troponin-negative angina to STEMI, cardiogenic shock, or cardiac arrest. In addition, the management pathways of NSTE-ACS and STEMI patients are widely similar. Compared with previous editions of the guidelines, the extensive document is improved also from a graphic perspective, containing several appealing and easy-to-understand figures. New or modified recommendations include, among others, the topics of diagnostic work-up, timing of invasive strategy, revascularization in multi-vessel disease, intravascular imaging, cardiac arrest, cardiogenic shock, and antithrombotic treatment. For the first time in the field of ACS, ESC guidelines have incorporated a section on patient perspectives with dedicated recommendations. Some of the most relevant changes in recommendations impacting clinical practice are discussed in this article.

Abstract 16624: Patients’ Perspectives on the Impact and Management of Angina - Preliminary Results of the PACT-ANGINA International Survey

Introduction: PACT-ANGINA is a quality improvement initiative aimed to improve the understanding of challenges in the management of angina and chronic coronary syndromes. Hypothesis: An international patient survey is conducted to assess how angina and its management affect patients’ lives and what patients want in terms of the management of their angina. Methods: A working group that included 9 cardiologists and 7 patient representatives developed an online, anonymous questionnaire. Patients with angina were invited to take part in the survey by patient organizations and treating physicians. Results: Between January and June 2023, the survey was completed by 891 patients in 21 countries. The proportion of female patients was 46%. Among participants, 57% had been diagnosed with angina for 2 years or less, and 54% had never undergone a percutaneous coronary intervention. The proportion of patients with no history of smoking was 65% and the most common self-reported concomitant diseases were hypertension (49%), diabetes (38%) and dyslipidemia (23%). Pain, tightness, pressure or discomfort in the chest (89%), shortness of breath (44%), and fatigue (39%) were the most frequently reported symptoms, and 34% of participants felt that their physical activities were very or extremely limited by angina symptoms. The proportion of respondents who felt that angina was having a great or extreme impact on their quality of life was 37%. When asked to rate the relative importance of 9 treatment objectives, respondents assigned the highest priority to 1) reducing angina attacks and symptoms, 2) avoiding hospitalizations, and 3) prolonging their life as much as possible. Among different aspects of care, those considered the most important by respondents to improve the management of their angina were 1) a better follow-up of their symptoms, 2) practical and easy-to-understand information, and 3) lifestyle changes counseling. Conclusions: This study demonstrates that patients with angina are often limited by their symptoms, which impact their quality of life. Patient-centered management of angina is necessary to improve clinical care of such a common cardiac condition.

Endpoint adjudication in cardiovascular clinical trials.

Endpoint adjudication (EA) is a common feature of contemporary randomized controlled trials (RCTs) in cardiovascular medicine. Endpoint adjudication refers to a process wherein a group of expert reviewers, known as the clinical endpoint committee (CEC), verify potential endpoints identified by site investigators. Events that are determined by the CEC to meet pre-specified trial definitions are then utilized for analysis. The rationale behind the use of EA is that it may lessen the potential misclassification of clinical events, thereby reducing statistical noise and bias. However, it has been questioned whether this is universally true, especially given that EA significantly increases the time, effort, and resources required to conduct a trial. Herein, we compare the summary estimates obtained using adjudicated vs. non-adjudicated site designated endpoints in major cardiovascular RCTs in which both were reported. Based on these data, we lay out a framework to determine which trials may warrant EA and where it may be redundant. The value of EA is likely greater when cardiovascular trials have nuanced primary endpoints, endpoint definitions that align poorly with practice, sub-optimal data completeness, greater operator variability, and lack of blinding. EA may not be needed if the primary endpoint is all-cause death or all-cause hospitalization. In contrast, EA is likely merited for more nuanced endpoints such as myocardial infarction, bleeding, worsening heart failure as an outpatient, unstable angina, or transient ischaemic attack. A risk-based approach to adjudication can potentially allow compromise between costs and accuracy. This would involve adjudication of a small proportion of events, with further adjudication done if inconsistencies are detected.

Health care use and costs attributable to cardiovascular disease in Ireland: a cross-sectional study

Abstract Cardiovascular disease (CVD) is the leading cause of mortality and disability in Europe but the use of health services and costs associated with CVD are poorly quantified. We examined health service use attributable to CVD and corresponding costs in Ireland. Data on 8113 participants aged 50+ of the first wave of The Irish Longitudinal Study on Ageing was used. CVD was defined as having a self-reported doctor diagnosis of myocardial infarction, angina, heart failure, stroke, atrial fibrillation or transient ischaemic attack. Outcomes were the self-reported number of general practitioner (GP) and outpatient department (OPD) visits, accident and emergency department (A&amp;E) attendances and hospitalisations over the 12 months preceding the interview. Negative binomial regression adjusted for socio-demographic confounders and other chronic conditions was used to study the effects of CVD on the outcomes. Average marginal effects (AME) were estimated to examine the additional use of health services attributable to CVD. We estimated the total additional costs attributable to CVD at the population level using Census 2022 data. Participants with CVD reported higher utilization of all health services. In adjusted models, having CVD was associated with additional 1.19 (95% CI: 0.99, 1.39) GP and 0.79 (95% CI: 0.65, 0.93) OPD visits over the past year. There were twice as many additional hospitalisations attributable to CVD in males compared to females (AME: 0.20 (95% CI: 0.16, 0.23) in males vs AME: 0.10 (95% CI: 0.07, 0.14) in females), with no difference observed in the additional use of other healthcare services by gender or age groups. The population-level costs of the additional healthcare service use attributable to CVD were an estimated €352.2 million (95% CI: €272.8, €431.7), 93% of which was due to use of secondary care services. There is a substantial additional use of health services due to CVD in Ireland, with hospital admissions being the biggest contributor to costs. Key messages • The vast majority of additional costs attributable to CVD in Ireland are generated through use of secondary care services. • While a shift is being implemented in Ireland to manage uncomplicated CVD cases in primary care, sustained efforts aimed at CVD primary prevention are required to contain health service costs.

Tongxinluo capsule in combination with conventional therapies for stable angina pectoris: A meta-analysis and systematic review.

This study aimed to assess the efficacy and safety of Tongxinluo capsule (TXLC) in combination with conventional therapies for treating stable angina pectoris (SAP) through a comprehensive meta-analysis and systematic review. We conducted a systematic search of the China National Knowledge Infrastructure, Wanfang, VIP, PubMed, Embase, and CENTRAL databases for randomized controlled trials investigating the use of TXLC as adjuvant therapy for SAP published up to June 2023. The Cochrane Handbook was used to evaluate the risk of bias. Meta-analysis was performed using Review Manager 5.4.1, and publication bias was assessed using Begg test and Egger test in the Stata SE 12.0 software. GRADEpro was used to assess the quality of the evidence. This meta-analysis included 26 randomized controlled trials with a total of 2352 patients. TXLC co-administration demonstrated significant reduction in angina attack frequency (mean difference (MD) -0.91, 95% confidence interval (CI) -0.97 to -0.84, P < .00001) and duration (MD -1.71, 95% CI -2.24 to -1.19, P < .00001), decreased use of nitroglycerin tablets (MD -6.28, 95% CI -7.16 to -5.41, P < .00001), lowered C-reactive protein (MD -1.19, 95% CI -1.35 to -1.03, P < .00001) and low-density lipoprotein cholesterol levels (MD -0.68, 95% CI -0.86 to -0.51, P < .00001). TXLC co-administration did not increase gastrointestinal reactions (RR 1.17, 95% CI 0.38 to 3.57, P = .78). The Begg test and Egger test results indicated no publication bias. The evidence quality was rated as very low for frequency of angina attack, duration of angina attack, and nitroglycerin usage, and low for C-reactive protein, low-density lipoprotein cholesterol levels, and gastrointestinal reaction events. This meta-analysis supports TXLC as a beneficial adjunct treatment for SAP.

Peculiarities of the Course of Arterial Hypertension and Stable Coronary Heart Disease in Conditions of Distress and the Feasibility of Additional Therapy

Today, in Ukraine in war conditions there are the powerful and long-term stress factors in the population, according to the intensity of the constant negative psycho-emotional impact theses stress factors form a state of distress. Distress, as an additional significant pathogenetic reason, affects the change in the prevalence and course of cardiovascular diseases. The article describes the stages and individual changes caused by distress. Diagnostic algorithms for the assessment of patients with arterial hypertension and coronary heart disease in distress conditions for a differentiated change in therapy are provided, namely the strengthening of the basic recommended therapy or the inclusion in the treatment of additional therapy: phytotherapy or vasoactive biosupplements. Among the last mentioned substances, donors of nitric oxide (NO), whose main substrate for synthesis in the body is L-arginine, have undoubted advantages. According to modern studies and meta-analyses, the use of L-arginine improves the endothelial function of blood vessels, has antioxidant properties, thanks to which it has been proven that it decreases blood pressure, reduces the feeling of anxiety, improves physical performance, reduces the number of angina attacks, including microvascular one, has a positive effect on the lipid profile in general, with a probable decrease in the level of triglycerides. Our own data on the oral use of the L-arginine biosupplement with a decrease in the variability of blood pressure, the frequency of cardiac pain, and an improvement in general well-being are presented. The presence of population-wide distress reactions makes it possible for the patient to use the supplement independently to alleviate/eliminate maladaptive effects from the cardiovascular and central nervous systems.

Outcome indicators in clinical trials on traditional Chinese medicine treatment of microvascular angina

This study reviewed the current status of the use of outcome indicators in randomized controlled trial(RCT) on traditional Chinese medicine(TCM) treatment of microvascular angina(MVA) and analyzed the existing problems and possible solutions, aiming to provide a basis for the design of high-quality RCT and the establishment of core outcome sets for MVA. CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase, Cochrane Library, Web of Science, and 2 clinical trial registries were searched for the RCT on TCM treatment of MVA according to pre-defined criteria. The Cochrane's risk of bias assessment tool was used to evaluate the methodological quality of the included RCT and the use of outcome indicators was summarized. A total of 69 RCTs were included, from which 100 outcome indicators were extracted, with the frequency of 430. The extracted outcome indicators belonged to 8 domains: response rate, symptoms and signs, physical and chemical examinations, TCM efficacy, safety, quality of life, economic evaluation, and long-term prognosis. The indicators of physical and chemical examinations were the most(70 indicators with the frequency of 211), followed by those of response rate(7 indicators with the frequency of 73) and symptoms and signs(7 indicators with the frequency of 54). The outcome indicators with higher frequency were adverse reactions, angina attack frequency, clinical efficacy, endothelin-1, total duration of treadmill exercise, and hypersensitive C-reactive protein. The RCT on TCM treatment of MVA had the following problems: irregular reporting of adverse reactions, diverse indicators with low frequency, lack of attention to the application of endpoint indicators, insufficient use of TCM differentiation and efficacy indicators, non-standard evaluation criteria and failure to reflect the basic characteristics of TCM. A unified MVA syndrome differentiation standard should be established, on the basis of which an MVA treatment efficacy evaluation system and core outcome indicator set that highlights the characteristics of TCM with patient-reported outcomes as the starting point should be established to improve the clinical research and research value.

Effect of Traditional Chinese Medicine combined with Western Medicine on blood lipid levels and inflammatory factors in patients with angina pectoris in coronary heart disease identified as intermingled phlegm and blood stasis syndrome: a network Meta-analysis.

To evaluate the clinical efficacy of Traditional Chinese Medicine prescriptions for resolving phlegm in the treatment of angina pectoris of phlegm-stasis coronary heart disease by a network Meta-analysis. Randomized controlled trials (RCTs) on clinical efficacy of CHD angina pectoris with interaction of phlegm and blood stasis were searched in PubMed, Springer, the Cochrane Library and Chinese-language databases China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Data from their inception to December 2021. Literature was screened and literature bias risk was assessed by RevMan5.4 software. The overall response rate, the duration of angina attack, the levels of serum lipids such as total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), and high density lipoprotein cholesterol (HDL-C), and expression of hypersensitive C-reactive protein (hs-CRP) were selected as outcome indicators for network Meta-analysis and mapped using Stata15.1 software. Totally, 26 RCTs were included, involving 2098 participants. There were 6 TCM formulas with the effects of dispelling phlegm and removing blood stasis. Taking conventional Western Medicine as the common intervention measures, the results showed that the overall response improvement rate from high to low was displayed as modified Xiaoxianxiong decoction (, MXD), Danlou tablet (, DT), modified Gualou Xiebai Banxia decoction (, MGXBD), modified Wendan decoction (, MWD), modified Zhishi Xiebai Guizhi decoction (, MZXGD), and modified Erchen decoction (, MED). The sequence of angina attack duration improvement from high to low was MZXGD, MGXBD, DT, MWD, MXD. The sequence of TC improvement from high to low was MZXGD, MED, DT, and MGXBD. Sequence of improving TG from high to low was MED, MZXGD, MGXBD, and DT. For LDL-C improvement, the effect from good to poor was MZXGD, MGXBD, DT, and MED. With regard to HDL-C improvement, the effect was ranked as MED, MZXGD, MGXBD, and DT from good to poor. hs-CRP expression from high to low was MZXGD, MXD, MED, MWD, and MGXBD. TCM formula with the effects of dispelling phlegm and removing blood stasis combined with conventional Western Medicine has obvious advantages in treating CHD angina pectoris with interaction of phlegm and blood stasis. MZXGD has great potential in increasing the overall response rate, reducing Duration of angina attack improving blood lipids, and reducing inflammatory factors. However, due to the limitations of extant studies, the conclusions of this study need to be confirmed by numerous reasonably-designed RCTs.