Evidence supporting the use of: Nitrate
For the health condition: Angina

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Synopsis

Source of validity: Scientific
Rating (out of 5): 5

Nitrates, such as nitroglycerin, are scientifically validated treatments for angina pectoris. Their primary mechanism of action involves vasodilation—specifically, the relaxation of vascular smooth muscle via the release of nitric oxide (NO), which leads to increased levels of cyclic guanosine monophosphate (cGMP). This effect reduces myocardial oxygen demand by decreasing both preload (venous return to the heart) and, at higher doses, afterload (arterial resistance). By lowering the heart's workload, nitrates alleviate the chest pain associated with angina, which is caused by an imbalance between myocardial oxygen supply and demand.

The use of nitrates in angina management is supported by extensive clinical evidence and decades of clinical practice. Sublingual nitroglycerin, introduced in the late 19th century, remains a first-line therapy for acute angina attacks, as well as for prophylaxis before activities known to provoke angina. Randomized controlled trials and meta-analyses have consistently demonstrated their efficacy in reducing angina symptoms and improving exercise tolerance in patients with stable and unstable angina.

Leading clinical guidelines, including those from the American College of Cardiology (ACC) and European Society of Cardiology (ESC), recommend nitrates for both acute relief and prevention of angina episodes. While they do not improve long-term prognosis or reduce mortality, their symptomatic benefits are well established, making them a cornerstone in the management of angina.

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