Antianginal
drug treatment reduces symptoms and
ischemia but may also influence the prognosis of patients with
stable angina pectoris. The
Atenolol Silent
Ischemia Study (ASIST) compared
atenolol and placebo treatment (about 140 patient-years on each) in patients with mainly silent
ischemia and found less aggravation of angina and a tendency toward fewer cardiac complications with
atenolol treatment. The Total Ischaemic Burden European Trial (TIBET) compared slow release
nifedipine,
atenolol, or the combination (about 450 patient-years on each) and found no significant differences with regard to cardiac complications, a nonsignificant trend toward better prognosis on combined treatment, and more side effects on
nifedipine alone compared with the other treatments. The Angina Prognosis Study in Stockholm (APSIS) compared
metoprolol and
verapamil (about 1,400 patient-years on each) and found similar effects on cardiovascular endpoints, tolerability, and psychosocial variables with the 2 treatments. Hypothesis-generating subgroup analyses in APSIS suggest that treatment effects may differ in hypertensive and diabetic subgroups. Beneficial effects in primary and
secondary prevention, together with data from ASIST, suggest that beta 1 blockade influences prognosis favorably. The safety of short-acting
nifedipine in
ischemic heart disease is questioned, but TIBET data suggest that slow release
nifedipine may be safe.
Verapamil has beneficial effects after
myocardial infarction (Danish
Verapamil Infarction Trial II) and shows similar efficacy as
metoprolol in the APSIS study. The paucity of placebo data (antianginal treatment cannot be withheld during long periods of time in symptomatic patients) precludes firm conclusions regarding effects of
drug treatment on prognosis. It is argued that patients with
stable angina pectoris do well on medical treatment, and that beta 1 blockers,
verapamil, and, possibly, slow-release
nifedipine may influence their prognosis favorably.