In the management of stable angina pectoris the first aim of treatment is to relieve symptoms (morbidity) by reducing myocardial oxygen demand, with a further aim of reducing mortality if possible. Nitrates, calcium channel blockers and the potassium channel opening agent nicorandil are all of symptomatic benefit. In the IONA study nicorandil reduced hospital admissions with angina (IONA Study Group, 2002). Eight per cent of the study subjects had diabetes, and there was similar benefit in the diabetes subgroup (IONA Study Group, 2004). As in non-diabetic subjects there are relatively few data that show prognostic benefit of pharmacological treatments for patients with stable angina, in contrast to patients following acute myocardial infarction (see Chapter 4). The most compelling evidence for prognostic benefit in diabetic subjects comes from subgroup analysis of multicentre studies for beta-blockers and ACE inhibitors, and from subgroup and meta-analysis of antiplatelet therapy.
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