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Antianginal and anti-atherosclerotic efficacy of the standard therapy for IHD, its combination with isosorbide dinitrate and nicorandil in patients with angina and obesity

Solodova Yu. A., Adamchik A. S.
State Budgetary Educational Institution of Higher Professional Education, “Kuban State Medical University” of the RF Ministry of Health Care, Sedina 4, Krasnodar 350063

Keywords: coronary heart disease, exertional angina, nicorandil, obesity, oxidative damage

DOI: 10.18087/rhj.2016.1.2170

Background. Due to continuously growing number of IHD patients, search for new approaches in the treatment of obese patients with angina is highly relevant. Aim. To study anti-ischemic and anti-atherosclerotic effects of a standard therapy for IHD, a treatment including nicorandil (Cordinik, PIK-FARMA) and isosorbide dinitrate in long-term treatment of patients with stable angina and obesity. Materials and methods. The study included 93 patients with FC II-III exertional angina randomized to three groups. All patients received a standard therapy for IHD. Isosorbide dinitrate was added to the therapy of group 2 patients, and nicorandil was added to the therapy of group 3 patients. Examination of patients included measurement of weight, height and BWI, EchoCG, cycle ergometry (СEM), Doppler ultrasound of carotid arteries (DUSCA), reactive hyperemia test, measurements of blood high-sensitivity C-reactive protein (hs-CRP), fibrinogen, total cholesterol, LDL, and TG; requirement for nitroglycerin was determined before and after 24 weeks of treatment. Results. The inclusion of nicorandil or isosorbide dinitrate into the standard therapy resulted in greater changes in the clinical course of disease, reduced endothelial dysfunction and atherogenic processes, and decreased levels of proinflammatory markers. These effects were more pronounced in subgroups with normal weight and overweight than in subgroups with obesity. Conclusion. High prevalence of obesity in the population and its role in the pathogenesis of IHD require more detailed study of this issue and a comprehensive approach to management of patients with angina in combination with overweight and obesity.
  1. Kones R. Recent advances in the management of chronic stable angina I: approach to the patient, diagnosis, pathophysiology, risk stratification, and gender disparities. Vasc Health Risk Manag. 2010 Aug 9;6:635–56.
  2. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB et al. Heart disease and stroke statistics-2012 update: a report from the American Heart Association. Circulation. 2012 Jan 3;125 (1):e2‑e220.
  3. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G et al. Executive summary: heart disease and stroke statistics – 2010 update: a report from the American Heart Association. Circulation. 2010 Feb 23;121 (7):948–54.
  4. Ikeda U. Inflammation and coronary artery disease. Curr Vasc Pharmacol. 2003 Mar;1 (1):65–70.
  5. Ridker PM. Testing the inflammatory hypothesis of atherothrombosis: scientific rationale for the cardiovascular inflammation reduction trial (CIRT). J Thromb Haemost. 2009 Jul;7 (Suppl 1):332–9.
  6. Verma S, Anderson TJ. Fundamentals of endothelial function for the clinical cardiologist. Circulation. 2002 Feb 5;105 (5):546–9.
  7. Mudau M, Genis A, Lochner A, Strijdom H. Endothelial dysfunction: the early predictor of atherosclerosis. Cardiovasc J Afr. 2012 May;23 (4):222–31.
  8. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013 Oct;34 (38):2949–3003.
  9. Parker JD, Parker JO. Nitrate therapy for stable angina pectoris. N Engl J Med. 1998 Feb 19;338 (8):520–31.
  10. Reid J. Organic nitrate therapy for angina pectoris. Med J Aust. 1994 Feb 7;160 (3):129–33.
  11. Munzel T, Daiber A, Gori T. Nitrate therapy: new aspects concer­ning molecular action and tolerance. Circulation. 2011 May 17;123 (19):2132–44.
  12. Gayet JL, Paganelli F, Cohen-Solal A. Update on the medical treatment of stable angina. Arch Cardiovasc Dis. 2011 Oct;104 (10):536–44.
  13. Kinoshita M, Sakai K. Pharmacology and therapeutic effects of nicorandil. Cardiovasc Drugs Ther. 1990 Aug;4 (4):1075–88.
  14. Meany TB, Richardson P, Camm AJ, Coltart J, Griffith M, Maltz MB, Signy M. Exercise capacity after single and twice-daily doses of nicorandil in chronic stable angina pectoris. Am J Cardiol. 1989 Jun 20;63 (21):66–70.
  15. Airaksinen KE, Huikuri HV. Antiarrhythmic effect of repeated coronary occlusion during balloon angioplasty. J Am Coll Cardiol. 1997 Apr;29 (5):1035–8.
  16. Sakamoto T, Kaikita K, Miyamoto S, Kojima S, Sugiyama S, Yoshimura M, Ogawa H. Effects of nicorandil on endogenous fibrinolytic capacity in patients with coronary artery disease. Circ J. 2004 Mar;68 (3):232–5.
  17. Izumiya Y, Kojima S, Kojima S, Araki S, Usuku H, Matsubara J et al. Long-term use of oral nicorandil stabilizes coronary plaque in patients with stable angina pectoris. Atherosclerosis. 2011 Feb;214 (2):415–21.
  18. Markham A, Plosker GL, Goa KL. Nicorandil. An updated review of its use in ischaemic heart disease with emphasis on its cardioprotective effects. Drugs. 2000 Oct;60 (4):955–74.
  19. Sekiya M, Sato M, Funada J, Ohtani T, Akutsu H, Watanabe K. Effects of the long-term administration of nicorandil on vascular endothelial function and the progression of arteriosclerosis. J Cardiovasc Pharmacol. 2005 Jul;46 (1):63–7.
  20. Kasama S, Toyama T, Sumino H, Kumakura H, Takayama Y, Ichikawa S et al. Long-term nicorandil therapy improves cardiac sympathetic nerve activity after reperfusion therapy in patients with first acute myocardial infarction. J Nucl Med. 2007 Oct;48 (10):1676–82.
  21. Kasama S, Toyama T, Hatori T, Kumakura H, Takayama Y, Ichikawa S et al. Comparative effects of nicorandil with isosorbide mononitrate on cardiac sympathetic nerve activity and left ventricular function in patients with ischemic cardiomyopathy. Am Heart J. 2005 Sep;150 (3):477.
  22. IONA Study Group. Effect of nicorandil on coronary events in patients with stable angina: the Impact Of Nicorandil in Angina (IONA) randomised trial. Lancet. 2002 Apr 13;359 (9314):1269–75.
  23. Thomas GR, DiFabio JM, Gori T, Parker JD. Once daily therapy with isosorbide-5‑mononitrate causes endothelial dysfunction in humans: evidence of a free-radical-mediated mechanism. J Am Coll Cardiol. 2007 Mar 27;49 (12):1289–95.
  24. Kjekshus J, Apetrei E, Barrios V, Böhm M, Cleland JG, Cornel JH et al. Rosuvastatin in older patients with systolic heart failure. N Engl J Med. 2007 Nov 29;357 (22):2248–61.
Solodova Yu. A., Adamchik A. S. Antianginal and anti-atherosclerotic efficacy of the standard therapy for IHD, its combination with isosorbide dinitrate and nicorandil in patients with angina and obesity. Russian Heart Journal. 2016;15 (1):16–23

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