Importance of the field: Despite improved mortality and morbidity in the treatment of coronary artery disease, a significant proportion of patients will continue to experience recurrent angina pectoris. Areas covered in this review: Anti-anginal therapy has long been dominated by the use of beta-blockers, Ca2+ channel blockers and nitrates. Most recently, ranolazine was introduced as a new anti-anginal class. This review article presents current and novel anti-anginal strategies under development. A discussion of their molecular mechanisms that may complement traditional therapies is presented. Medline and PubMed scientific search tools were primarily used to identify relevant literature dating from 1970 to 2008. What the reader will gain: This review provides a summary of both traditional and emerging therapeutic approaches to angina pectoris management. A discussion on the mechanism of action and clinical efficacy of ranolazine, trimetazidine, nicorandil, ivabradine, fasudil and growth factor gene therapy as anti-anginal agents is provided. Take home message: The need for multiple approaches cannot be overemphasized. Availability of various modalities would strongly enhance the ability to meet the needs of a heterogeneous patient population. Patients with recurrent angina pectoris most likely will require multi-drug regimen where different mechanisms may complement each other and result in a more efficacious strategy.
