title: Use of nitrates in ischemic heart disease.
abstract: Short-acting nitrates are beneficial in acute myocardial ischemia. However, many unresolved questions remain about the use of long-acting nitrates in stable ischemic heart disease. The use of long-acting nitrates is weakened by the development of endothelial dysfunction and tolerance. Also, we currently ignore whether lower doses of transdermal nitroglycerin would be better than those presently used. Multivariate analysis data from large nonrandomized studies suggested that long-acting nitrates increase the incidence of acute coronary syndromes, while data from another multivariate study indicate that they have positive effects. Because of methodological differences and open questions, the two studies cannot be compared. A study in Japanese patients with vasospastic angina has shown that, when compared with calcium antagonists, long-acting nitrates do not improve long-term prognosis and that the risk for cardiac adverse events increases with the combined therapy. We have many unanswered questions.
authors.affiliation: Cardiology Office , Marktgasse 10 A, CH-4310 Rheinfelden , Switzerland +004161 831 45 55 ; +004161 833 97 56 ; praxis@cocco.ch.
authors.forename: Cocco
authors.initials: C
authors.lastname: Giuseppe
authors.forename: Jerie
authors.initials: J
authors.lastname: Paul
authors.forename: Iselin
authors.initials: I
authors.lastname: Hans-Ulrich
mesh_terms: D000787:Angina Pectoris / Q000188:drug therapy; D003324:Coronary Artery Disease / Q000139:chemically induced / Q000188:drug therapy; D003692:Delayed-Action Preparations; D004361:Drug Tolerance; D006801:Humans; D017202:Myocardial Ischemia / Q000188:drug therapy*; D009566:Nitrates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005996:Nitroglycerin
chemical_list: D003692:Delayed-Action Preparations; D009566:Nitrates; D005996:Nitroglycerin
keywords: glyceryl-trinitrate; isosorbide-5-mononitrate; isosorbide-dinitrate; nitrates; nitroglycerin; pentaerythritol tetranitrate