Coronary artery disease
Mismatch between myocardial oxygen demand and coronary supply. Includes stable angina and post-infarction states without acute instability.
ICD-10 I255 drugs
Also known as: CAD, Ischemic heart disease, IHD, Chronic coronary syndrome
Drugs used for this condition
- AAmlodipineFirst line · Calcium channel blockers (dihydropyridines)In stable angina amlodipine reduces attack frequency and nitroglycerin use: in the CAPE trial attacks became less frequent in 70% of patients versus 44% on placebo. ESC 2024 no longer splits antianginal drugs into first and second line: treatment starts with a beta-blocker or a calcium channel blocker according to the patient profile, and the two are combined if the effect is insufficient; AHA/ACC 2023 places both classes side by side. Amlodipine does not abort an attack; a short-acting nitrate is needed for that. In the CAMELOT trial, in patients with confirmed coronary disease and a mean blood pressure of 129/78 mmHg, the rate of cardiovascular events over two years fell from 23.1% to 16.6%, mainly through fewer hospitalisations for angina and revascularisations; an effect on death or myocardial infarction is not proven, so antiplatelets and statins are not stopped. The AEMPS label also lists vasospastic angina, which has its own card. Contraindications: severe hypotension, shock, severe aortic stenosis, haemodynamically unstable heart failure after myocardial infarction; in NYHA class III–IV heart failure pulmonary oedema was more frequent. CYP3A4 inhibitors (clarithromycin, azole antifungals, diltiazem, verapamil) raise amlodipine exposure.
- ABisoprololFirst line · Selective beta-adrenergic blockersBeta-blockers are first-line anti-anginal therapy in stable angina. They reduce heart rate, myocardial oxygen demand, and angina frequency. Target resting heart rate is 55–60 bpm.
- AMetoprololFirst line · Selective β1-adrenoceptor blockersBeta-blockers are first-line in stable angina. Metoprolol reduces heart rate and myocardial oxygen consumption, decreasing angina attack frequency. After MI, beta-blockers reduce the risk of recurrent MI and sudden death. Target resting heart rate is 55–60 bpm.
- BIsosorbide dinitrateSecond line · Organic nitrate, nitric oxide donorIsosorbide dinitrate is used for prophylaxis and treatment of angina attacks in coronary artery disease. ESC and SEC place nitrates as second-line antianginal therapy after beta-blockers and calcium antagonists. The drug does not reduce mortality in stable angina but relieves symptoms. For sublingual use in acute attack nitroglycerin is preferred (faster onset).
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit