title: Oral sirolimus: A possible treatment for refractory angina pectoris in the elderly.
abstract: Refractory angina pectoris (RAP) is a clinical problem, frequently encountered in the elderly, associated with high health-care costs. Until recently, the goal of RAP treatment aimed at improving the quality of life (QoL) because it was thought that mortality rates were not different between stable angina pectoris and RAP. Our purpose was at determining whether any mortality rate difference exists and whether any novel therapeutical solution might be translated into clinical practice. We therefore performed a literature review to assess current optimal treatment of RAP patients, including all studies involving the use of oral sirolimus and stents, although no consistent evidence was found for any specific treatment to improve survival, apart from minor QoL amelioration. A large mortality difference was seen between RAP and stable angina pectoris. On the other hand, therapeutic approaches to RAP patients showed frequent complications and several contraindications, depending on the procedure. We propose to inhibit instead of stimulating angiogenesis, by giving oral sirolimus, an immunosuppressive drug, thereby decreasing the atherosclerotic process and its evolution. Sirolimus was shown to decrease left ventricular mass (thus indirectly decreasing myocardial oxygen needs and consumption). It might stop and, in some cases, even enable regression of plaque progression. Sirolimus side effects are mild to moderate and wash-out rapidly at treatment discontinuation. Compared with current therapies sirolimus treatment is more health-care cost efficient. It should be important to design a trial in RAP patients powered to reduce mortality and QoL increase.
authors: Invasive Cardiology Unit, Centre Hospitalier de Montluçon, 18 Avenue du 8 Mai 1945, 03100 Montluçon, France. Electronic address: alexandru_mischie@yahoo.com.
authors: Alexandru
authors: A
authors: Mischie
authors: Invasive Cardiology Unit, Centre Hospitalier de Montluçon, 18 Avenue du 8 Mai 1945, 03100 Montluçon, France. Electronic address: s.chanseaume@ch-montlucon.fr.
authors: Sylvain
authors: S
authors: Chanseaume
authors: Invasive Cardiology Unit, Centre Hospitalier de Montluçon, 18 Avenue du 8 Mai 1945, 03100 Montluçon, France. Electronic address: p.gaspard@ch-montlucon.fr.
authors: Philippe
authors: P
authors: Gaspard
authors: Carol Davila University of Medecine, 37 Dionisie Lupu, 1st District, 020022 Bucharest, Romania. Electronic address: ccatalina97@yahoo.com.
authors: Catalina Liliana
authors: CL
authors: Andrei
authors: Carol Davila University of Medecine, 37 Dionisie Lupu, 1st District, 020022 Bucharest, Romania. Electronic address: crinasinescu@gmail.com.
authors: Crina
authors: C
authors: Sinescu
authors: Department of Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy. Electronic address: michele.schiariti@uniroma1.it.
authors: Michele
authors: M
authors: Schiariti
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D020123:Sirolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus
keywords: CAD; Refractory angina; Sirolimus; Stents; Survival