Review: The management of stable angina in diabetes

Williams, Ian; Vazir, Ali; Zaman, Azfar

doi:10.1177/14746514030030010301

Cited by 3 publications

(6 citation statements)

References 90 publications

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“…The results of the present study show that animals with IR are less resistant to isoproterenol-induced acute cardiac ischemia as indicated by the significantly larger depression in ST height and higher serum LDH activity compared with control. This is in agreement with clinical literature where MetS is associated with a high incidence of coronary atheroma and an increased risk of fatal coronary events [ 26 ]. The fructose-induced model of MetS was associated with clear arterial atheroma in previous work of our laboratories [ 17 ].…”

Section: Discussionsupporting

confidence: 93%

Xanthine oxidase inhibition alleviates the cardiac complications of insulin resistance: effect on low grade inflammation and the angiotensin system

El-Bassossy

Watson

2015

Journal of Translational Medicine

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BackgroundWe have previously shown that hyperuricemia plays an important role in the vascular complications of insulin resistance (IR). Here we investigated the effect of xanthine oxidase (XO) inhibition on the cardiac complications of IR.MethodsIR was induced in rats by a high fructose high fat diet for 12 weeks. Allopurinol, a standard XO inhibitor, was administered in the last 4 weeks before cardiac hemodynamics and electrocardiography, serum glucose, insulin, tumor necrosis factor alpha (TNFα), 8-isoprostane, uric acid, lactate dehydrogenase (LDH) and XO activity were measured. Expression of cardiac angiotensin II (AngII) and angiotensin receptor 1 (AT1) were assessed by immunofluorescence.ResultsIR animals had significant hyperuricemia which was inhibited by allopurinol administration. IR was associated with impaired ventricular relaxation (reflected by a decreased diastolic pressure increment and prolonged diastolic duration) and XO inhibition greatly attenuated impaired relaxation. IR was accompanied by cardiac ischemia (reflected by increased QTc and T peak trend intervals) while XO inhibition alleviated the ECG abnormalities. When subjected to isoproterenol-induced ischemia, IR hearts were less resistant (reflected by larger ST height depression and higher LDH level) while XO inhibition alleviated the accompanying ischemia. In addition, XO inhibition prevented the elevation of serum 8-isoprostane and TNFα, and blocked elevated AngII and AT1 receptor expression in the heart tissue of IR animals. However, XO inhibition did not affect the developed hyperinsulinemia or dyslipidemia.ConclusionsXO inhibition alleviates cardiac ischemia and impaired relaxation in IR through the inhibition of low grade inflammation and the angiotensin system.

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Section: Discussionsupporting

confidence: 93%

Xanthine oxidase inhibition alleviates the cardiac complications of insulin resistance: effect on low grade inflammation and the angiotensin system

El-Bassossy

Watson

2015

Journal of Translational Medicine

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“…It has been widely agreed that in diabetes and IR, the heart is less resistant to ischemia during anginal attacks. In addition, the metabolic syndrome is associated with a high incidence of coronary atheroma and an increased risk of a fatal coronary event [16]. In the present study, PTX administration significantly alleviated the ischemia induced in the hearts of IR animals as indicated by the significant decrease in ST height depression compared with the untreated IR group.…”

Section: Discussionsupporting

confidence: 58%

Pentoxifylline Alleviates Cardiac Ischemia and Dysfunction Following Experimental Angina in Insulin Resistance

Azhar

El-Bassossy

2014

PLoS ONE

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We have previously shown that pentoxifylline (PTX) protects from vascular complications associated with insulin resistance (IR). Here, we investigated the protective effect of PTX against cardiac ischemia and dysfunction following experimental angina in IR. IR, along with its accompanying cardiac dysfunction, was induced in rats by a high-fructose (10% in drinking water) high-fat diet for 12 weeks. PTX was administered daily (30 mg⋅kg−1) during the last 4 weeks of the study. Experimental angina was induced by isoproterenol (10 µg⋅kg−1) administered by intravenous injection. Both before (baseline) and after the experimental angina, cardiac contractility was assessed by continuous recording in anesthetized rats via a microtip catheter inserted in the left ventricle, and cardiac conductivity was determined by a surface electrocardiograph. Serum glucose, insulin, tumor necrosis factor-α (TNFα), and adiponectin levels and lipid profile were also determined. Feeding the rats a high-fructose high-fat diet produced IR, as evidenced by significant hyperinsulinemia and hyperglycemia, and PTX administration did not affect this IR. When subjected to experimental angina, IR hearts were less resistant to the ischemia following induction of angina (reflected by the large ST height depression) compared with controls, and PTX completely prevented the excessive ST height depression in IR animals. In addition, left ventricular pressure development was largely attenuated during and after induction of angina in IR animals compared with controls. PTX administration prevented the excessive attenuation in ventricular pressure development in IR animals. IR was associated with elevated levels of the inflammatory cytokine TNFα, whereas PTX treatment elevated the serum level of the anti-inflammatory cytokine adiponectin. PTX alleviates cardiac ischemia and dysfunction following experimental angina in IR directly through inhibition of the low-grade inflammation that accompanies IR.

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“…3,4 The term "refractory angina" (RA) refers to the chronicity of symptoms (≥3 months in duration) and failure of symptom control with a combination of optimal medical therapy and revascularization methods. [5][6][7] Between 5% and 10% of patients who undergo cardiac catheterization have RA. However, there is no specific data on how this condition affects diabetic patients.…”

Section: Introductionmentioning

confidence: 99%

“…In a study conducted by Kosiborod et al on patients with concomitant T2DM, CAD, and chronic stable angina who remain symptomatic despite antianginal medication (TERISA trial), weekly angina frequency (AF) was considerably reduced with ranolazine compared to placebo. 5 The effectiveness of antianginal drugs in patients who have both stable angina and T2DM is not well studied. 6 Some antianginal medications, such as beta-blockers and calcium channel blockers, can worsen the glycemic control of these patients, so it is important to choose anti-anginal drugs that have a neutral or positive impact on them.…”

Section: Introductionmentioning

confidence: 99%

“…Ranolazine, one of the newest and most well‐known antianginal medications, which has a fundamentally different mechanism of action than empagliflozin, has been studied in patients with angina. In a study conducted by Kosiborod et al on patients with concomitant T2DM, CAD, and chronic stable angina who remain symptomatic despite antianginal medication (TERISA trial), weekly angina frequency (AF) was considerably reduced with ranolazine compared to placebo 5 …”

Section: Introductionmentioning

confidence: 99%

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Antianginal effects of empagliflozin in patients with type 2 diabetes and refractory angina; a randomized, double‐blind placebo‐controlled trial (EMPT‐ANGINA Trial)

Mansouri,

Sadeghi

et al. 2023

Clinical Cardiology

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IntroductionSodium–glucose cotransporter 2 (SGLT2) inhibitors are emerging antidiabetic agents with various potential cardiovascular benefits. The EMPT‐ANGINA trial examined the effect of empagliflozin on the angina burden in those with concurrent type 2 diabetes mellitus (T2DM) and refractory angina (RA).MethodIn this 8‐week, double‐blind, randomized, placebo‐controlled trial, 75 patients with T2DM and RA were randomly assigned to one of two groups: empagliflozin (n = 37) and placebo (n = 38). The primary outcome was an improvement in angina, which was assessed by the Seattle Angina Questionnaire (SAQ). The secondary outcomes of this study included alterations in the SAQ domains and exercise test components.ResultsThe mean age of individuals in the empagliflozin and placebo groups was 67.46 ± 9.4 and 65.47 ± 7.0 years, respectively (p = .304). Patients who received empagliflozin showed a significant improvement in both the primary endpoint, which was the SAQ Summary Score (192.73 ± 20.70 vs. 224 ± 25.36, p < .001) and the secondary endpoints. Exercise test components, including treadmill exercise duration, time till angina, 1 mm ST‐segment depression onset, and heart rate (HR) recovery, were all significantly improved in the empagliflozin group. This positive impact was reached with no clinically significant changes in resting and exertion HR or blood pressure. There were no significant side effects in the empagliflozin group (p = .125).ConclusionEmpagliflozin can be safely added as a metabolic modulator agent to existing antianginal medications in individuals with concurrent T2DM and RA to reduce angina symptoms and enhance exercise capacity with minimal side effects.

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Review: The management of stable angina in diabetes

Cited by 3 publications

References 90 publications

Xanthine oxidase inhibition alleviates the cardiac complications of insulin resistance: effect on low grade inflammation and the angiotensin system

Xanthine oxidase inhibition alleviates the cardiac complications of insulin resistance: effect on low grade inflammation and the angiotensin system

Pentoxifylline Alleviates Cardiac Ischemia and Dysfunction Following Experimental Angina in Insulin Resistance

Antianginal effects of empagliflozin in patients with type 2 diabetes and refractory angina; a randomized, double‐blind placebo‐controlled trial (EMPT‐ANGINA Trial)

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