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      Role of short-acting nitroglycerin in the management of ischemic heart disease

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          Abstract

          Nitroglycerin is the oldest and most commonly prescribed short-acting anti-anginal agent; however, despite its long history of therapeutic usage, patient and health care provider education regarding the clinical benefits of the short-acting formulations in patients with angina remains under-appreciated. Nitrates predominantly induce vasodilation in large capacitance blood vessels, increase epicardial coronary arterial diameter and coronary collateral blood flow, and impair platelet aggregation. The potential for the prophylactic effect of short-acting nitrates remains an under-appreciated part of optimal medical therapy to reduce angina and decrease myocardial ischemia, thereby enhancing the quality of life. Short-acting nitroglycerin, administered either as a sublingual tablet or spray, can complement anti-anginal therapy as part of optimal medical therapy in patients with refractory and recurrent angina either with or without myocardial revascularization, and is most commonly used to provide rapid therapeutic relief of acute recurrent angina attacks. When administered prophylactically, both formulations increase angina-free walking time on treadmill testing, abolish or delay ST segment depression, and increase exercise tolerance. The sublingual spray formulation provides several clinical advantages compared to tablet formulations, including a lower incidence of headache and superiority to the sublingual tablet in terms of therapeutic action and time to onset, while the magnitude and duration of vasodilatory action appears to be comparable. Furthermore, the sublingual spray formulation may be advantageous to tablet preparations in patients with dry mouth. This review discusses the efficacy and utility of short-acting nitroglycerin (sublingual spray and tablet) therapy for both preventing and aborting an acute angina attack, thereby leading to an improved quality of life.

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          Most cited references 55

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          Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology.

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            Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population.

            A population-based survey, using data from the Framingham study, assessed sex-specific patterns of coronary heart disease occurring over a 26-year period of time. Among subjects ages 35 to 84 years, men have about twice the total incidence of morbidity and mortality of women. The sex gap in morbidity tends to diminish during the later years of the age range, mainly because of a surge in growth of female morbidity after age 45 years, while by that age, the growth in the male rate begins to taper off. An approximate 10-year difference between the sexes persists in mortality rates throughout the life span. The relative health advantage that is possessed by women, however, is buffered by a case fatality rate from coronary attacks that exceeds the male rate (32% vs 27%). Coronary disease manifestations differ between the sexes. Myocardial infarction is more likely to be unrecognized in women than in men (34% vs 27%). Angina pectoris in women more frequently is uncomplicated (80%), whereas in men angina tends to evolve out of infarction (66%). Also, sudden death comprises a greater proportion of male deaths than female deaths (50% vs 39%). Because women maintain a lesser probability of the disease than do men at any level of the major cardiovascular risk factors, distinctions in their risk factor profiles do not explain completely the observed disease patterns.
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              2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

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                Author and article information

                Journal
                Drug Des Devel Ther
                Drug Des Devel Ther
                Drug Design, Development and Therapy
                Drug Design, Development and Therapy
                Dove Medical Press
                1177-8881
                2015
                19 August 2015
                : 9
                : 4793-4805
                Affiliations
                [1 ]Department of Medicine, Division of Cardiology, Albany Medical College, Albany, NY, USA
                [2 ]Department of Medicine, Division of Cardiology, Albany Stratton Veterans Affairs Medical Center, Albany, NY, USA
                [3 ]Department of Medicine, Division of Cardiology, Albany Medical Center, Albany, NY, USA
                [4 ]Department of Pharmacy, Albany College Pharmacy and Health Sciences, Albany, NY, USA
                [5 ]Department of Angiology, Medical University of Brandenburg & Charité, Berlin, Germany
                Author notes
                Correspondence: Mandeep S Sidhu, Department of Medicine, Division of Cardiology, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA, Tel +1 518 262 5076, Fax +1 518 262 5082, Email sidhum@ 123456mail.amc.edu
                Article
                dddt-9-4793
                10.2147/DDDT.S79116
                4548722
                26316714
                © 2015 Boden et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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