ORIGINAL ARTICLE
Possibilities of antianginal therapy in improvement of quality of life of patients with stable angina of effort
 
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Medical and social assessment, urgent and ambulatory care. First Moscow State Medical University named after I. M. Sechenov, Moscow, Russia
Online publish date: 2018-03-20
Publish date: 2018-03-20
 
Electron J Gen Med 2018;15(4):em43
KEYWORDS:
ABSTRACT:
Objective:
High prevalence of ischemic heart disease (IHD) is currently both of medical and social concern, thus requiring treatment with drugs capable of influencing not only the prognosis of the disease but also quality of life of patients. This study was undertaken to investigate the possibilities of antianginal therapy with nicorandil and isosorbide dinitrate in order to improve quality of life of patients with stable angina pectoris.

Method:
The authors carried out a comprehensive examination of a total of eighty-four 44-to-76-year-old patients suffering from IHD with functional class 2-3 stable angina of effort and followed up in ambulatory settings. The patients were randomized into two groups of treatment to receive either nicorandil or isosorbide dinitrate as antianginal agents added to basic therapy. The groups of patients did not significantly differ by anamnestic and demographic characteristics. The duration of follow up amounted to 24 months. We determined the physical and mental components of health-related quality of life and their dynamics on the background of antianginal therapy with nicorandil and isosorbide dinitrate. The parameters of quality of life were evaluated by the findings of two screening tools: the General Health Questionnaire (GHQ-28) and Seattle Angina Questionnaire (SAQ).

Results:
The findings obtained within the timeframe of the study demonstrated that patients suffering from FC 2-3 stable angina of effort and taking standard therapy with beta-adrenoblokers, calcium antagonists, and antiplatelet drugs were found to have a decrease in their quality of life. The lowest scores were observed by the scales reflecting the psychological component of health, whereas the scores of physical limitation, angina stability, and angina frequency were considerably better. After 24 weeks of treatment with nicorandil and isosorbide dinitrate, the patients of both groups were found to have significantly improved scores for quality of life assessed by the SAQ on all scales. Initially high scores by the GHQ characterizing the patient’s psychological discomfort were revealed in both groups of patients, with no statistically significant differences between the groups. The highest score was revealed by the scales of somatic symptoms and social dysfunction in both the nicorandil group (11.8 and 13.2 points, respectively) and isosorbide dinitrate group (12.1 and 13.5 points, respectively). The mentioned alterations underline the significance of such disease as IHD in adaptation of the patient to the social environment. Angina attacks, physical limitations lead to deterioration of the emotional state and interfere with daily activity. High scores by the scales of anxiety and depression suggested a low level of mental health of IHD patients with stable angina pectoris. After 24 months of treatment, manifestations of anxiety and depression in patients of both groups significantly decreased (with the results comparable in both groups), with clear advantage in the nicorandil group.

Conclusion:
Nicorandil turned out to be superior to isosorbide dinitrate in improvement of physical and psychological components of quality of life of patients with stable angina of effort.

 
REFERENCES (25):
1. Afanasieva EV. Assessment of health-related quality-of-life. Good Clinical Practice. 2010;1:56-58.
2. Novik AA, Ionova TP. Manual on studying quality of life in medicine. Under the editorship of Shevchenko Yu. P., member of Russian Academy of Medical Sciences. St. Petersburg. Moscow: “Neva” Publishing House; 2007.
3. Kind P, Williams A. Measuring success in health care – the time has come to do it properly. Health Policy Matter. 2004;9:1-8.
4. Krom IL, Erugina MV, Sazanova GY. Assessment of medical care in the context of quality of life in patients with ischemic heart disease. Fundamental Studies. 2015;1(6):1174-1177.
5. Shalnova SA, Konradi AO, Karpov YA, Kontzevaya AV, Deev AD, Kapustina AV. Analysis of mortality due to cardiovascular disease in 12 regions of the Russian Federation, participating in the study “Epidemiology of Cardiovascular Disease in Various Regions of Russia”. Russian Cardiological Journal. 2012;5:6-11.
6. Arnold SV, Kosiborod M, McGuire DK. Effects of ranolazine on quality of life among patients with diabetes mellitus and stable angina. JAMA Intern Med. 2014;174(8):1403. https://doi.org/10.1001/jamain....
7. Tendera M, Chassany O, Ferrari R. Quality of life with ivabradine in patients with angina pectoris. Circ Cardiovasc Qual Outcomes. 2016;9(1):31-8. https://doi.org/10.1161/CIRCOU....
8. Cardiovascular Prevention. National Guidelines. All-Russian Scientific Society of Cardiology. Cardiovascular Therapy and Prevention. 2011;6(2):57-64.
9. Montalescot G, Sechtem U. 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;34(38):2949-3003. https://doi.org/10.1093/eurhea....
10. Secco GG, Parisi R, Mirabella F. Old and New Drugs for Treatment of Stable Angina: New Anti-Anginal Drugs and Coronary Revascularization. Cardiovasc Hematol Agents Med Chem. 2015;13(1):21-24. https://doi.org/10.2174/187152... PMid:25544117.
11. Egorov VA, Shilova EV, Martzevich SY. Choice of nitrates therapy in patients with stable angina pectoris: comparative study of ordinary tablets of isosorbide dinitrate and different dosage forms of isosorbide-5-mononitrate. Rational Pharmacotherapy in Cardiology. 2008;2:19-22.
12. Zhilyaev EV. Nitrates in treatment of stable angina: new horizons. Consilium Medicum. 2010;1:14-18.
13. Roland E. Safety profile of an anti-anginal agent with potassium channel opening activity: an overview. Europ. Heart J. 1993;14:40–47. https://doi.org/10.1093/eurhea....
14. Shimbo D, Grahame-Clarke C, Miyake Y, Rodriguez C, Sciacca R, Di Tullio M, Boden-Albala B, Sacco R, Homma S. The association between endothelial dysfunction and cardiovascular outcomes in a population-based multi-ethnic cohort. Atherosclerosis. 2007;192(1):197-203. https://doi.org/10.1016/j.athe... PMid:16762358.
15. Kitakaze M, Asakura M, Kim J. Human atrial natriuretic peptide and nicorandil as adjuncts to reperfusion treatment for acute myocardial infarction (J-WIND): two randomised trials. Lancet. 2007;27:1483–93. https://doi.org/10.1016/S0140-....
16. Sizova ZM, Zakharova VL, Shamieva ES, Kozlova NV. Possibilities of nicorandil in correction of the coronary reserve and endothelial dysfunction in patients with ischemic heart disease. Heart. 2013;2(70);12:75-81.
17. Sizova ZM, Kozlova NV, Zakharova VL, Shameeva ES. Comparative assessment of effects of isosorbide dinitrate, isosorbide-5-mononitrate and nicorandil on the frequency of angina attacks and endothelial vasoregulating function in patients with ischemic heart disease. Cardiology. 2015;2:10-15. https://doi.org/10.18565/cardi....
18. Martsevich SY, Kutishekno NP, Deev AD. Studying the effect of nicorandil on quality of life in patients with stable angina of effort within the framework of the KVAZAR study. Rational Pharmacotherapy in Cardiology. 2016;12(6):654-660. https://doi.org/10.20996/1819-....
19. Martsevich SY, LukinaYV, Kutishekno NP. An observational multicentre study of nicorandil in patients with stable ischaemic heart disease and high cardiovascular risk. Russian Cardiological Journal. 2017; :75-82. https://doi.org/10.15829/1560-....
20. Spertus JA, Winder JA, Dewhurst TA. Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease. J Am Coll Cardiol. 1995;25(2):333-341. https://doi.org/10.1016/0735-1....
21. Spertus JA, Winder JA, Dewhurst TA. Monitoring the quality of life in patients with coronary artery disease. Am J Cardiol.1994;74(12):1240-1254. https://doi.org/10.1016/0002-9....
22. Spertus JA, Jones P, McDonell M. Health status predicts long-term outcome in outpatients with coronary disease. Circulation.2002; 106(1):43-9. https://doi.org/10.1161/01.CIR....
23. Agarwal S, Schechter C, Zaman A. Assessment of functional status and quality of life after percutaneous coronary revascularisation in octogenarians. Age Ageing. 2009;38(6):748-51. https://doi.org/10.1093/ageing....
24. Seki S, Kato N, Ito N. Validity and reliability of Seattle angina questionnaire Japanese version in patients with coronary artery disease. Asian Nurs Res. 2010;4(2):57-63. https://doi.org/10.1016/S1976-....
25. Shore S, Smolderen KG, Kennedy KF. Health status outcomes in patients with acute myocardial infarction after rehospitalization. Circ Cardiovasc Qual Outcomes. 2016;9(6):777-84. https://doi.org/10.1161/CIRCOU....
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