Disease of the Month – Angina

Shots:

Characterized by discomfort or pain in the chest, Angina develops when the heart does not receive adequate oxygen-rich blood

PharmaShots’ Disease of the Month report aims to familiarize the general population with conditions impacting communities worldwide. The report outlines disease characteristics, types, symptoms, diagnosis, treatments, epidemiology, market size, clinical trial analysis, patient advocacy groups (PAGs), and heart-touching patient stories

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Angina is a common condition that affects around 11M people (about twice the population of Arizona) in the US. The chest pain associated with Angina is often confused with a heart attack. Though both are the consequences of coronary artery disease, they differ in the extent of damage to the heart. With this enlightening article, let’s unfold Angina like never before, understand the preventive measures, available treatment options, and much more [1]

Angina can be classified into four different types based on its cause and interventional needs: [1,2]

Stable Angina: It is triggered by activity or stress that lasts minutes and gradually eases with rest. It’s not a heart attack but may signal a higher risk

Unstable Angina: It can occur at rest, with severe, long-lasting, and recurring pain

Microvascular Angina: It causes chest pain without artery blockage, due to poor function of small coronary vessels. It can last up to 10 minutes and is more common in women

Variant (Prinzmetal) Angina: This rare form of angina occurs at rest or during sleep when heart arteries suddenly tighten, causing severe pain and requiring treatment

Refractory Angina: This form of angina doesn’t respond to medication or treatments like stent placement.

Angina is caused by reduced blood flow to the heart (myocardial ischemia), often due to problems in the coronary arteries, such as: [3]

Coronary Artery Disease (CAD): The most common cause of angina is atherosclerosis, where plaque builds up in the coronary arteries, narrowing or hardening them and reducing blood flow to the heart

Coronary Microvascular Disease: This condition, more common in women, damages the small blood vessels branching from coronary arteries, which are not visible on standard CAD tests and require specialized testing

Coronary Artery Spasm: Coronary spasms cause your arteries to tighten and relax repeatedly, briefly reducing blood flow to the heart. They can occur without coronary artery disease.

Angina symptoms include chest pain or discomfort, which may feel like: [4]

Burning

Fullness

Pressure

Squeezing

Pain may also spread to the arms, neck, jaw, shoulder, or back. Other angina symptoms include:

Dizziness

Fatigue

Nausea

Shortness of breath

Sweating

To diagnose angina, a healthcare provider reviews your symptoms, examines you, and asks about risk factors like family history of heart disease. [4]

A healthcare provider will diagnose angina using different tests:

Electrocardiogram (ECG or EKG): An ECG is a quick, painless test that records the heart’s electrical activity using electrodes on the chest, arms, and legs. It detects abnormal heart rhythms and signs of a current or past heart attack

Chest X-ray: A chest X-ray helps in identifying causes of chest pain and detecting an enlarged heart

Blood Tests: Blood tests can help detect cardiac enzymes and proteins that leak into the blood after heart damage from a heart attack

Stress Test: A stress test checks angina by monitoring the heart during exercise, like walking or biking. If you can’t exercise, medicine may be used to mimic its effects. Other tests may be done at the same time

Echocardiogram: It uses ultrasound to create a picture of your heart, showing how well it’s squeezing and how the valves are functioning

Nuclear Stress Test: A nuclear stress test uses a radioactive tracer and a scanner to assess blood flow to the heart at rest and during stress. Low or no tracer in an area indicates poor blood flow

Cardiac Computed Tomography (CT) or Magnetic Resonance Imaging (MRI): Cardiac CT and MRI create images of the heart to diagnose problems and assess damage. CT uses X-rays; MRI uses magnetic fields and radio waves. Both involve lying in a tubelike machine

Coronary Angiogram: This test uses X-rays to examine the heart’s blood vessels and is part of a procedure called cardiac catheterization.

Treatment focuses on improving blood flow and reducing complications by addressing the underlying heart issues. Your provider will examine you and run tests to choose the best approach. Common treatments include: [3]

Anticoagulants or antiplatelet drugs to lower your risk of blood clots

Blood pressure medications

Cholesterol medications

Medications used specifically to treat angina

Lifestyle changes

Coronary artery bypass grafting (CABG

Percutaneous coronary intervention (PCI), also called coronary angioplasty and stenting

Enhanced external counterpulsation (EECP)

General Prevalence:
Chronic stable angina affects approximately 30,000 to 40,000 people per million in Western countries. [5]

Age-Related Prevalence: [5]

Ages 45–64:

Men: 4% to 7%

Women: 5% to 7%

Ages 65–84:

Men: 14% to 15%

Women: 10% to 12%

Sex: Prevalence increases with age in both men and women. [5]

In 2024, the global Angina treatment market was valued at $12.43B and is projected to reach $15.71B by 2030, growing at a CAGR of 4.0% from 2024 to 2030.

Lipitor (atorvastatin calcium) is indicated to treat angina in adults [7]

Approved therapies include Lopressor (Alembic Pharmaceuticals), Lipitor (Viatris), Plavix (Sanofi & BMS), Fragmin (Pfizer), NitroMist (Akrimax Pharmaceuticals), Nitrostat (Viatris), NORLIQVA (CMP Pharma), and Procardia XL (Pfizer)

Active & Inactive Trials of P-II & P-III are concentrated in the US, followed by Canada, and Germany. (Data was extracted on June 18, 2025)

Individuals with angina and other cardiovascular conditions have access to several patient advocacy groups dedicated to improving their quality of life.

Arthur

My name is Arthur. I am a Scot but have lived in London for nearly forty years.

In 2014, I had my first heart attack. In the following six years, I went to A&E at least twice a year. Every time, I was sent home and was told it was reflux.

My own doctor in about 2015/16 put me on half an angina pill. When I was in hospital, I was told by the cardiology doctors that I did not need it as I never had angina at all.

At the start, I was in and out of hospitals 40 plus times. Some side effects were extremely bad. For example, nausea and dizziness, etc. I had more than 28 blue light trips and three severe nose bleeds needing hospitalisation. In the end, after many months, I asked to get a second opinion, being fed up with being called a conundrum. Coronary vasospasm was the answer.

The vasospastic angina has had a tremendous effect on me in more ways than one.

I was told in the middle of last year, I had cardiac vasospasm which was extremely rare. At that time, I was told only the right combination of medication would bring it under control and have had three allergic reactions to pills which they gave me

Lorraine’s story

Lorraine Kinzel, 54, from Redruth, Cornwall, has experienced angina since having a heart attack in 2013.

After my heart attack, I’d get slight pains and heaviness in my chest if I pushed myself too much, for example, after a long walk with the dogs. This pain, called ‘stable angina’, would go quickly if I took my glyceryl trinitrate (GTN) spray, which I always carried in my handbag.

But in 2018, it became unstable angina: I started getting severe pains in my chest, jaw and neck, even when I was at rest. I was frightened it was building to another heart attack.

When I took the GTN spray, the pain eased but I’d feel drained. Because it was happening so frequently, sometimes multiple times a day, I wasn’t functioning as a parent. My older children had to take my youngest to school.

After a few months of this, my GP arranged an angiogram. This test showed that the two stents fitted to widen my arteries after the heart attack were still fine and my other arteries were not narrow enough to have new stents fitted.

I was put on ranolazine. This medication has been great for me. Now I only get angina once or twice a month when I’ve overdone things, like vacuuming the whole house. I manage it with my GTN spray and by resting.

Angina can be debilitating. Through the years, I’ve had support from my GP, my cardiac nurse and others who’ve gone through it, through Belle’s Hearties, an online woman’s group

References