2008, Volume 15, Supplement 1: Clinical implications of the inhibition of the late sodium current: a new paradigm in the treatment of ischaemic heart disease

A symposium, sponsored by CV Therapeutics Europe Ltd, was held during the British Cardiovascular Society (BCS) meeting in Manchester on 2 June 2008. This report is a summary of the symposium. ...

Reviewing whether chronic stable angina is a benign condition or whether it requires aggressive management, Professor Robert Wilcox (University Hospital, Nottingham) outlined how the subject of angina is fraught with problems of terms and definitions. What, for example, is ‘stable angina’? Does this relate to the frequency, predictability, duration, severity or the tolerability of the symptoms in an individual? Similarly, when does chronic stable angina become ‘refractory’? A patient who has previously had a myocardial infarction (MI) or an intervention such as a percutaneous coronary intervention (PCI) and now has chronic stable angina, must presumably be different from someone with angina who has not had an intervention, who presents to his general practitioner with exertional chest pain. It is reasonable to suppose that these two individuals will have different prognoses, he said....

Professor John Camm addressed the role of the late sodium current as a new target in ischaemic heart disease (IHD). The sodium channel itself spans the cardiac myocyte membrane and allows sodium transport from outside the cell to the inside of the cell. ...

“Diabetic patients, despite current therapies, have significant residual risk of cardiovascular events such that we need to think about new agents,” said Professor Mark Kearney (University of Leeds) in a review of the increased pernicious nature of ischaemic heart disease (IHD) in the setting of type 2 diabetes....

Professor Adam Timmis (Barts and the London NHS Trust) discussed the thorny issue of inequity in the management of angina, and he started by distinguishing between inequality and inequity. Inequality, such as differences in health between populations, is “an interesting observation”. For instance, in East London, standardised admission ratios with myocardial infarction rates are twice as high for South Asians as for whites. Also, mortality in women is twice as high following MI (for various reasons). Inequities, in contrast, are represented in different opportunities for healthcare between populations, for example, and “are potential embarrassments for us as cardiologists.” Thus, in 2003, prolonged door-to-needle times were observed in South Asians versus whites (42.5 vs. 26.0 minutes, respectively); and rates of discharge on beta blockers post-MI were lower in women (31.6%) than in men (44.9%)....