Nitrates as an Integral Part of Optimal Medical Therapy and Cardiac Rehabilitation for Stable Angina: Review of Current Concepts and Therapeutics

The goals of optimal medical therapy in patients with stable angina pectoris are to reduce the risk of cardiovascular mortality and future cardiovascular events, improve exercise capacity, and enhance quality of life. Whereas myocardial revascularization is frequently employed in the management of patients with stable angina, a variety of pharmacologic interventions are recommended as part of optimal medical management. The use of short- and rapidly-acting nitrates (eg, sublingual nitroglycerin spray and tablets) is at the core of the therapeutic armamentarium and should be integrated into optimal medical therapy for stable angina along with exercise therapy. The potential clinical implications from these observations are that prophylactic sublingual nitrates, when combined with cardiac rehabilitation, may allow the patient with angina to exercise to a greater functional capacity than without sublingual nitrates. Clin. Cardiol. 2012 DOI: 10.1002/clc.21993 William E. Boden: Advisory Board for Arbor Pharmaceuticals. Aloke V. Finn: Sponsored research agreement with Medtronic Vascular; Scientific Advisory Board for Medtronic Vascular; Advisory Board for Arbor Pharmaceuticals. Dharmesh Patel: Speakers Bureau for Novartis, Arbor Pharmaceuticals, Medtronic, Takeda Pharmaceuticals, Abbott, St Jude's Medical, Cleveland Heart Lab, Boston Heart Lab, Forrest Pharmaceuticals, Boehringer Ingelheim, and Jansen & Jansen. W. Frank Peacock: Advisory Board for Abbott, Alere, Arbor Pharmaceuticals, Lilly, and The Medicines Co; Received research grants from Alere, Brahms Comprehensive Research Associates, Electrocore, Novartis, The Medicines Co; Speakers Bureau for Abbott, Alere, and Electrocore; Ownership interest in EKR, Emergencies in Medicine, and Vital Sensors. Udho Thadani: Received consultation fee from Arbor Pharmaceuticals for interpretation of the study data and for writing this manuscript; Advisory Board for Arbor Pharmaceuticals; Consultant for Gilead Sciences, Astra Zeneca, Pfizer, Merck, Bristol-Myers Squibb, Bayer, Forest Laboratories, and Servier; Speaker's program for Eli Lilly and Daiichi-Sankyo and Gilead Sciences. Franklin H. Zimmerman: Advisory Board for Arbor Pharmaceuticals; Speakers Bureau for Boerhinger-Ingelheim. **At the time this manuscript was written, Dr Peacock's affiliation was: Department of Emergency Medicine, The Cleveland Clinic, Cleveland, Ohio.