Novel Drugs Approach in Treatment of Angina

Angina Pectoris is a common symptom of ischemic heart disease. In 1772 according to William Heberden Angina is characterized by the painful and disagreeable sensation that occurs in the breast during walking. This is caused as the result of the myocardial oxygen supply and demand imbalance. The oxygen demand increases due to tachycardia, hypertension, left ventricular hypertrophy. Tissue ischemia leads to series of metabolic changes which includes elevated intracellular lactate production and acidification that produces anginal symptoms. Besides coronary obstructive diseases, it also occurs following coronary vasospasm and with coronary microvascular diseases. Vasospastic angina also known as Prinzmetal’s angina results due to vasoreactivity of epicardial coronary arteries. Microvascular angina is also referred as Syndrome X resulting from constriction of coronary microvasculature. In 2-4% of adult population silent ischemia occurs in void of anginal manifestations.This review article discusses current and novel antianginal strategies under development. It focuses on the molecular mechanisms that may complement traditional therapies. The understanding of the clinical trials and endpoints is important in the evaluation of the new antianginal agents. Primary endpoints comprise exercise-based variables. Secondary endpoints comprise of amount of nitrate consumption and self-reporting of anginal frequency. Anti-anginal drugs are the pharmacological agents that reduce the frequency and severity of the anginal episodes.