Emerging treatments

Colchicine

Guidelines provide a weak recommendation that the anti-inflammatory agent colchicine may be considered for select patients with CCD who are at high-risk of subsequent events despite maximum tolerated guideline-directed management and therapy.[26]​ Trials of long-term therapy (1 to 3 years) have shown reduction in a combined cardiovascular outcome with a trend toward reduced cardiovascular death counterbalanced by a trend toward increased noncardiovascular death.[234][235]​​​ Limitations include GI adverse effects (which prompted 10% withdrawal during the run in phase of the largest study) as well as a narrow therapeutic index, drug interactions, and the need for dose adjustments in renal impairment.[26][234]​​​ Further studies are required to guide clinical practice.

Other antianginal therapies

Nicorandil and trimetazidine are antianginal agents that are not available in the US, but are used in other countries. The Medicines and Healthcare products Regulatory Agency (MHRA) in the UK has issued warnings concerning advice on the use of nicorandil.[236] There is limited evidence supporting the use of trimetazidine.​[237][238]

Other LDL-lowering therapies

Bempedoic acid and inclisiran are newer nonstatin therapies approved for use with diet and maximally tolerated statin therapy in adults who require additional lowering of LDL-C.[239]​ They may be selectively considered for high risk patients with severely or persistently elevated LDL despite use of (or for those unable to use) better established alternatives. Trials assessing clinical outcomes are ongoing, with one trial showing benefit in statin-intolerant patients.[240][241][242]

Coronary-sinus-reducing device

A coronary-sinus-reducing device has shown some promise in the small COSIRA trial, improving symptoms and quality of life in patients with refractory angina who were not candidates for revascularization.[243]

Use of this content is subject to our disclaimer