title: Update on ranolazine in the management of angina.
abstract: Mortality rates attributable to coronary heart disease have declined in recent years, possibly related to changes in clinical presentation patterns and use of proven secondary prevention strategies. Chronic stable angina (CSA) remains prevalent, and the goal of treatment is control of symptoms and reduction in cardiovascular events. Ranolazine is a selective inhibitor of the late sodium current in myocytes with anti-ischemic and metabolic properties. It was approved by the US Food and Drug Administration in 2006 for use in patients with CSA. Multiple, randomized, placebo-controlled trials have shown that ranolazine improves functional capacity and decreases anginal episodes in CSA patients, despite a lack of a significant hemodynamic effect. Ranolazine did not improve cardiovascular mortality or affect incidence of myocardial infarction in the MERLIN (Metabolic Efficiency with Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndrome)-TIMI (Thrombolysis In Myocardial Infarction) 36 trial, but significantly decreased the incidence of recurrent angina. More recently, ranolazine has been shown to have beneficial and potent antiarrhythmic effects, both on supraventricular and ventricular tachyarrhythmias, largely due to its inhibition of the late sodium current. Randomized controlled trials testing these effects are underway. Lastly, ranolazine appears to be cost-effective due to its ability to decrease angina-related hospitalizations and improve quality of life.
authors.affiliation: Einstein Center for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: J Nicolás
authors.initials: JN
authors.lastname: Codolosa
authors.affiliation: Einstein Center for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, USA.
authors.forename: Subroto
authors.initials: S
authors.lastname: Acharjee
authors.affiliation: Einstein Center for Heart and Vascular Health, Einstein Medical Center, Philadelphia, PA, USA ; Jefferson Medical College, Philadelphia, PA, USA.
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Figueredo
mesh_terms: D000083:Acetanilides / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000787:Angina Pectoris / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D002908:Chronic Disease; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D010879:Piperazines / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000069458:Ranolazine; D026941:Sodium Channel Blockers / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000083:Acetanilides; D000889:Anti-Arrhythmia Agents; D010879:Piperazines; D026941:Sodium Channel Blockers; D000069458:Ranolazine
keywords: chronic stable angina; coronary artery disease; ranolazine