Understanding the burden of chronic angina

Indication
  • Ranexa is indicated for the treatment of chronic angina.
  • Ranexa may be used with beta-blockers, nitrates, calcium channel blockers, anti-platelet therapy, lipid-lowering therapy, ACE inhibitors, and angiotensin receptor blockers.

Angina Prevalence in the US

From the National Health and Nutrition Examination Survey 2011-2014 (National Center for Health Statistics) and the National Heart, Lung, and Blood Institute.

Percentages for racial/ethnic groups are age-adjusted for US adults ≥ 20 years of age.

The incidence of new cases is for adults ≥ 45 years of age.

Chronic Angina and Specific Populations

Erectile dysfunction
In a cross-sectional Italian study, more than half of patients with chronic angina had ED

The cross-sectional Italian study consisted of 380 patients who underwent coronary angiography— 95 patients with coronary artery disease (CAD) reported having chronic angina.2

Chronic angina was defined as clinical and noninvasive evidence of stable myocardial ischemia lasting >2 months.

All patients underwent angiography for Acute Coronary Syndrome or Chronic CAD at the Institute of Cardiology of the University of Milan. Erectile function was evaluated using the erectile function domain of the International Index of Erectile Function (IIEF-EFD), a validated 15-item self-administered questionnaire. 50.5% (48/49) of patients with chronic angina were taking beta-blockers, although logistic regression analysis showed that beta-blockers did not have significant impact on ED when adjusted for other confounding variables.

ED=erectile dysfunction.

Diabetes mellitus
Angina prevalence did not differ among CAD patients with or without diabetes

1957 patients with coronary artery disease (CAD) were evaluated from the US National Health and Nutrition Examination Survey (NHANES) from 2001 to 2010.¶3

This study was supported by a contract from Gilead Sciences, Inc. to the University of California, Irvine. Drs Calara and Koch are employees of Gilead Sciences, Inc.

Percentages reported in the publication were calculated using population-weighted values. CAD defined by self-report. Diabetes mellitus defined by fasting glucose ≥126 mg/dL, nonfasting glucose ≥200 mg/dL, previous physician diagnosis of DM, or use of insulin or hypoglycemic medication. Angina was determined by either self-report or determined using the Rose Questionnaire for verified class 1 or class 2 angina pectoris.

DM=diabetes mellitus.

There is a disconnect between physician and patient reporting of angina symptoms

Is angina under-recognized in your patients? Assessing patient activity levels and the presence or absence of symptoms during patient visits is important in order to accurately estimate your patients’ angina burden.

In the APPEAR study of 1257 stable CAD patients from the ACC PINNACLE registry#4:

APPEAR (Angina Prevalence and Provider Evaluation of Angina Relief) is a cross-sectional study of stable CAD patients (N=1257) enrolled 2013-2015 from 25 US cardiology practices participating in the ACC PINNACLE registry. 8% (n=96) reported daily/weekly, 25% (n=315) reported monthly, and 67% (n=846) of patients reported no angina using the Seattle Angina Questionnaire.

PINNACLE (Practice INNovation And CLinical Excellence) is cardiology’s largest outpatient quality improvement registry, with over 3 million patients across 127 US sites. Gilead provided funding for this investigator-initiated study.4,6,7

Under-recognition was defined as the physician reporting a lower frequency of angina than the patient had reported using the Seattle Angina Questionnaire (SAQ) domain.

CAD=coronary artery disease.

Recurrent angina post-PCI  icon of a heart

Recurrent angina post-PCI

Learn more about the prevalence of chronic angina in patients post-PCI.

See the data
References:
  1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135:e1-e458.
  2. Montorsi P, Ravagnani P, Galli S, et al. Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J. 2006;27:2632-2639.
  3. Hui G, Koch B, Calara F, Wong ND. Angina in coronary artery disease patients with and without diabetes: US National Health and Nutrition Examination Survey 2001-2010. Clin Cardiol. 2016;39(1):30-36.
  4. Shafiq A, Arnold SV, Gosch K, et al. Patient and physician discordance in reporting symptoms of angina among stable coronary artery disease patients: insights from the Angina Prevalence and Provider Evaluation of Angina Relief (APPEAR) study. Am Heart J. 2016;175:94-100.
  5. Qintar M, Spertus JA, Gosch KL, et al. Effect of angina under-recognition on treatment in outpatients with stable ischaemic heart disease. Eur Heart J Qual Care Clin Outcomes. 2016;2(3):208-214.
  6. Eapen Z, Tang F, Jones P, et al. Variation in performance measure criteria for Million Hearts™ significantly affects practice rankings: results from 3,630,462 outpatients in 127 US practices from the NCDR® PINNACLE registry. J Am Coll Cardiol. 2014;63(12):A1297.
  7. Outpatient Registries. American College of Cardiology website. http://cvquality.acc.org/NCDR-Home/registries/outpatient-registries. Accessed July 7, 2017.
Important Safety Information
Contraindications