How do we further reduce angina in patients already treated with a hemodynamic agent? Benefits of adding a metabolic agent to other antianginal drugs (

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How do we further reduce angina in patients already treated with a hemodynamic agent? Benefits of adding a metabolic agent to other antianginal drugs (  -blockers, CCBs, nitrates…) in the treatment of stable angina International Journal of Cardiology Peng S et al. Int J Cardiol. 2014;177(3):

Prof Peng meta-analysis Methodology  13 randomized, controlled, clinical trials gathering 1628 patients  Assessing the efficacy of a metabolic agent in combination with other antianginal drugs (  -blockers, CCBs, nitrates…) vs other antianginal drugs in the treatment of stable angina  Treatment duration: 4 to 24 weeks End points:  Clinical and ergometric parameters Peng S et al. Int J Cardiol. 2014;177(3):

Prof Peng meta-analysis Results Weekly mean number of angina attacks WMD (95% CI) Adding a metabolic agent to other antianginal agents, significantly Decreases weekly number of angina attacks Decreases weekly nitrates consumption P < Peng S et al. Int J Cardiol. 2014;177(3):

Prof Peng meta-analysis Results weekly mean number of angina attacks WMD (95% CI) TOTAL WORK WMD (95% CI) P < P < EXERCISE DURATION WMD (95% CI) Adding a metabolic agent to other antianginal agents, significantly Increases total work at peak exercise by 0.82 METs Increases exercise duration at peak exercise by seconds Peng S et al. Int J Cardiol. 2014;177(3):

Prof Peng meta-analysis Discussion According to the authors: -“A metabolic agent optimizes cardiac metabolism, leading to an increase in the cell’s tolerance to ischemia” -“A metabolic agent combined with hemodynamic agents offers full additional efficacy while preserving tolerability” -“In contrast, studies pointed out the absence or little benefit provided by combined hemodynamic agents. This indicates the superiority of a metabolic agent as an adjunct treatment for stable angina pectoris” Peng S et al. Int J Cardiol. 2014;177(3):

Prof Peng meta-analysis Conclusion This meta-analysis confirms, in a large population, the efficacy of a metabolic agent in reducing angina and improving exercise capacity in angina patients. Moreover, it illustrates a fully additive efficacy of metabolic agent when combined with hemodynamic agents. Benefits of metabolic agent appear in the short term and are maintained in the long term. Peng S et al. Int J Cardiol. 2014;177(3):