Ranolazine improves insulin resistance in non-diabetic patients with coronary heart disease. A pilot study.
BACKGROUND
The aim of this pilot study was to evaluate if ranolazine (R) could improve insulin resistance (IR) in obese/overweight non-diabetic patients with coronary heart disease (CHD).


METHODS
The study enrolled 40 patients with already diagnosed CHD, previous revascularization, residual ischemia at ergometric test and IR. Mean age was 62.4±9years, M/F=31/9. Patients were randomly assigned to one of the two following groups: group 1 (20 patients) started R at dose of 500mg/bid; group 2 (20 patients) increased the dose of beta/blockers or calcium-channel blockers without introducing R. IR was defined as having HOMA-IR>2.5. At baseline and after 12weeks, all subjects performed an ergometric test and 12h fasting blood sample collection for determining glucose and insulin levels.


RESULTS
At 12weeks follow-up visit HOMA-IR significantly decreased in group 1 (from 3.1±1.7 to 2.3±0.9; p=0.02) while it remained unchanged in group 2 (from 3.0±1.4 to 2.8±1.2; p=0.14) (between groups p=0.009). At 12weeks follow-up visit patients of both groups obtained a significant increase of ischemic threshold at ergometric test, compared to baseline, (group 1 from 308.4±45s to 423.9±57s, p=0.0004); (group 1 from 315.7±63s to 441.2±51s, p=0.0001); without between groups difference (p=0.25).


CONCLUSIONS
Our data suggest that starting R, instead of increasing the dose of beta-blockers/calcium-channel blockers, could be a preferable choice in obese/overweight CHD subjects with residual ischemia after revascularization.
Department of Medical Sciences, IRCCS San Raffaele Pisana, Roma, Italy. Electronic address: giuseppe.caminiti@sanraffaele.it.
Giuseppe
G
Caminiti
Department of Medical Sciences, IRCCS San Raffaele Pisana, Roma, Italy.
Chiara
C
Fossati
Department of Medical Sciences, IRCCS San Raffaele Pisana, Roma, Italy.
Daniela
D
Battaglia
Department of Medical Sciences, IRCCS San Raffaele Pisana, Roma, Italy.
Rosalba
R
Massaro
Department of Medical Sciences, IRCCS San Raffaele Pisana, Roma, Italy.
Giuseppe
G
Rosano
Department of Medical Sciences, IRCCS San Raffaele Pisana, Roma, Italy.
Maurizio
M
Volterrani
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2; D005080:Exercise Test / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D010865:Pilot Projects; D000069458:Ranolazine / Q000627:therapeutic use*
D002317:Cardiovascular Agents; D000069458:Ranolazine
Coronary heart disease; Insulin resistance; Ranolazine