Daijiworld Media Network - New Delhi
New Delhi, Oct 31: Nicorandil has shown significant benefits in improving exercise capacity, coronary blood flow and quality of life among patients with heart failure with preserved ejection fraction (HFpEF) and coronary microvascular dysfunction (CMD), according to a randomised controlled trial.
The study, which followed 113 patients over 24 months, found that those receiving nicorandil alongside standard treatment experienced greater improvements than patients receiving usual treatment alone. Researchers said the findings suggest that the drug could offer a potential treatment option for patients with these conditions.
Participants were divided into two groups, with 57 receiving oral nicorandil at a dose of 5 mg three times daily along with their usual treatment, while 56 received standard treatment alone.
All participants had HFpEF and CMD without significant narrowing of the major coronary arteries. CMD was identified through a coronary flow reserve (CFR) of less than 2.0, indicating impaired blood flow through the heart's small blood vessels.
The primary measure was the change in exercise capacity, assessed through the six-minute walk distance (6MWD). Researchers also evaluated coronary flow reserve, levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), quality of life and a combined outcome of death from any cause or hospitalisation due to heart failure.
Better walking capacity and blood flow
After 24 months, the nicorandil group recorded an average improvement of 38.6 metres in the six-minute walking test, compared with 13.5 metres among patients receiving usual treatment alone.
The drug was also associated with improved coronary microcirculation. The mean CFR reached 2.10 in the nicorandil group, compared with 1.85 in the control group, with the difference reported as statistically significant.
Patients receiving nicorandil also experienced greater reductions in NT-proBNP levels, a biomarker associated with heart failure, along with better physical and mental quality-of-life scores.
Larger trials needed
Nicorandil was generally well tolerated during the study. One patient discontinued the medication due to headache and dizziness, which resolved after treatment was stopped. No serious adverse reactions were reported.
Researchers concluded that nicorandil improved exercise capacity, coronary microcirculation, heart failure-related biomarkers and quality of life among patients with HFpEF and CMD.
However, they cautioned that the findings should be interpreted carefully because the trial involved a relatively small number of patients and was conducted at a single centre. The study was also not sufficient to establish whether the improvements would translate into fewer deaths or heart failure-related hospitalisations.
The researchers called for larger, multicentre trials to confirm the findings and assess the drug's impact on major cardiovascular outcomes.