The Role of Nicorandil in the Management of Chronic Coronary Syndromes in the Gulf Region
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REVIEW
The Role of Nicorandil in the Management of Chronic Coronary Syndromes in the Gulf Region Kevin Cheng
. Khaldoon Alhumood . Fayez El Shaer
.
Ranil De Silva
Received: September 11, 2020 / Accepted: November 19, 2020 The Author(s) 2020
ABSTRACT Chronic coronary syndromes (CCS) and stable angina are a growing clinical burden worldwide. This is of particular concern in the Gulf region given its high prevalence of cardiovascular risk factors, especially diabetes mellitus and smoking. Despite recommendations on the use of first- and second-line anti-anginal medication, management challenges remain. Current guidelines for pharmacologic treatment are not determined by the range of pathophysiological mechanisms of ischaemia and consequent angina, which may occur either in isolation or co-exist. In this article, we highlight the need to improve knowledge of the epidemiology of chronic
K. Cheng R. De Silva (&) Specialist Angina Service, Royal Brompton and Harefield NHS Foundation Trust, London, UK e-mail: [email protected] K. Cheng R. De Silva Vascular Science Department, National Heart and Lung Institute, London, UK K. Alhumood Al Adan Hospital, Safat, Kuwait F. El Shaer Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia F. El Shaer National Heart Institute, Cairo, Egypt
coronary syndromes in the Middle East and Gulf region, and the need for studies of stratified pharmacologic approaches to improve symptomatic angina and quality of life in the large and growing number of patients with coronary artery disease from this region. We discuss the role of nicorandil, currently recommended as a second-line antianginal drug in CCS patients, and suggest that this may be a particularly useful add-on therapy for patients in the Gulf region.
Keywords: Chronic coronary syndrome; Gulf region; Nicorandil; Nitrates; Stable angina Key Summary Points CCS is a growing clinical burden worldwide, particularly in the Gulf region. Current guideline recommendations for anti-anginal escalation have a limited evidence base. Nitrates are frequently used for the treatment of CCS but have their limitations. Nicorandil is a useful therapeutic option offering vasodilatory and cardioprotective effects. Nicorandil has a contemporary randomised evidence base and a favourable clinical profile.
Adv Ther
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Patients with suspected CAD and ‘stable’ anginal symptoms, and/or dyspnoea Patients with new onset heart failure or left ventricular dysfunction and suspected CAD Asymptomatic and symptomatic patients with stabilised symptoms \ 1 year after acute coronary syndrome (ACS) or with recent revascularisation Patients with angina and suspected vasospastic or microvascular diseas
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