Improving exercise tolerance in patients with coronary heart disease: nicorandil in the spotlight

Mozhyna T.L.

Main
Publications
Improving exercise tolerance in patients with coronary heart disease: nicorandil in the spotlight

September 8, 2023

1206

Cardiology, Rheumatology

Mozhyna T.L.

УДК: 612.172.2+616.127-005.8

DOI: 10.32471/umj.1680-3051.156.246246

Keywords :

ischemic heart disease,

myocardial infarction,

nicorandil

Specialities :

Cardiology, Rheumatology

Resume

According to modern guidelines, treating patients with stable coronary artery disease and chronic coronary syndrome aims to reduce symptoms and prevent complications and maintain performance, which requires good exercise tolerance. Satisfactory exercise tolerance is determined by several factors, among which the leading role is played by such indicators as pre- and post-exercise myocardial workload, viable myocardial volume, and left ventricular ejection fraction. Exercise tolerance can be improved with drug therapy, in particular, with nicorandil, an effective antianginal agent that has been shown to improve prognosis in patients with coronary heart disease. Modern randomized trials and meta-analyses have shown that nicorandil reduces myocardial pre- and post-load, limits infarct size and increases left ventricular ejection fraction in the short and long term, and improves global left ventricular strain, which is associated with increased exercise tolerance.

References

1. http://www.dec.gov.ua/wp-content/uploads/2021/12/2021_10_26_kn_stabilna-ihs.pdf.
2. Knuuti J., Wijns W., Saraste A. et al. (2020) ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur. Heart J., 41(3): 407–477. doi: 10.1093/eurheartj/ehz425.
3. Fine N.M. (2023) Сердечная недостаточность. http://www.msdmanuals.com.
4. IONA Study Group (2022) Effect of nicorandil on coronary events in patients with stable angina: the Impact Of Nicorandil in Angina (IONA) randomized trial. Lancet, 359(9314): 1269–1275. doi: 10.1016/S0140-6736(02)08265-X.
5. Horinaka S., Yabe A., Yagi H. et al. (2010) Effects of nicorandil on cardiovascular events in patients with coronary artery disease in the Japanese Coronary Artery Disease (JCAD) study. Circ. J., 74(3): 503–509. doi: 10.1253/circj.cj-09-0649.
6. Sakata Y., Nakatani D., Shimizu M. et al. (2012) Oral treatment with nicorandil at discharge is associated with reduced mortality after acute myocardial infarction. J. Cardiol., 59(1): 14–21. doi: 10.1016/j.jjcc.2011.08.001.
7. Pearce L., Carr R.D., Yellon D. et al. (2023) Nicorandil — an Effective Multitarget Drug for Cardioprotection? Cardiovasc. Drugs Ther., 37(1): 5–8.
8. Cheng K., Alhumood K., El Shaer F. et al. (2021) The Role of Nicorandil in the Management of Chronic Coronary Syndromes in the Gulf Region. Adv. Ther., 38(2): 925–948. doi: 10.1007/s12325-020-01582-w.
9. El-Kashef D.H., Sharawy M. (2023) Hepatoprotective effect of nicorandil against acetaminophen-induced oxidative stress and hepatotoxicity in mice via modulating NO synthesis. Environ. Sci. Pollut. Res. Int., 30(6): 14253–14264.
10. Yamanaka M., Tamura Y., Kuribayashi-Okuma E. et al. (2023) Nicorandil protects podocytes via modulation of antioxidative capacity in acute puromycin aminonucleoside-induced nephrosis in rats. Am. J. Physiol. Renal. Physiol., 324(2): F168–F178. doi: 10.1152/ajprenal.00144.2022.
11. Du X., Ma Z., Li L. et al. (2021) Nicorandil Decreases Renal Injury in Patients With Coronary Heart Disease Complicated With Type I Cardiorenal Syndrome. J. Cardiovasc. Pharmacol., 78(5): e675–e680. doi: 10.1097/FJC.0000000000001117.
12. Kato K., Asanoi H., Wakabayashi C. et al. (1987) Effect of nicorandil on exercise performance in patients with effort angina: a multicenter trial using a treadmill exercise test. J. Cardiovasc. Pharmacol., 10 Suppl. 8: S98–S103.
13. Meany T.B., Richardson P., Camm A. et al. (1989) Exercise capacity after single and twice-daily doses of nicorandil in chronic stable angina pectoris. Am. J. Cardiol., 63(21): 66J–70J. doi: 10.1016/0002-9149(89)90208-7.
14. Jia Q., Shi S., Yuan G. et al. (2020) The effect of nicorandil in patients with cardiac syndrome X: A meta-analysis of randomized controlled trials. Medicine (Baltimore), 99(37): e22167. doi: 10.1097/MD.0000000000022167.
15. Xu L., Wang L., Li K. et al. (2019) Nicorandil prior to primary percutaneous coronary intervention improves clinical outcomes in patients with acute myocardial infarction: a meta-analysis of randomized controlled trials. Drug Des. Devel. Ther., 13: 1389–1400. doi: 10.2147/DDDT.S195918.
16. Li Y., Zhao C., Xiong C. et al. (2022) Clinical Effect of Nicorandil Combined with Aspirin in the Treatment of Myocardial Ischemia. Biomed. Res. Int., 2022: 2214411.
17. Ji Z., Zhang R., Lu W. et al. (2020) The effect of nicorandil in patients with acute myocardial infarction undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Ir. J. Med. Sci., 189(1): 119–131.
18. Zhou J., Xu J., Cheng A. et al. (2020) Effect of nicorandil treatment adjunctive to percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis. J. Int. Med. Res., 48(11): 300060520967856.
19. Wang S., Duan Y., Feng X. et al. (2019) Sustained nicorandil administration reduces the infarct size in ST-segment elevation myocardial infarction patients with primary percutaneous coronary intervention. Anatol. J. Cardiol., 21(3): 163–171.
20. Qian G., Zhang Y., Dong W. et al. (2022) Effects of Nicorandil Administration on Infarct Size in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: The CHANGE Trial. J. Am. Heart Assoc., 11(18): e026232. doi: 10.1161/JAHA.122.026232.
21. Chakraborty R. (2023) Nicorandil, Novel Potassium Adenosine Triphosphate Channel (K⁺ATP) Opener in Ischemia With Non-Obstructive Coronary Arteries (INOCA) and Atherosclerotic Cardiovascular Disease (ASCVD): Delphi Consensus Statement. Cureus, 15(1): e33624. doi: 10.7759/cureus.33624.
22. https://compendium.com.ua/info/354749/nikorel_/