title: Pharmacological Management of Chronic Stable Angina: Focus on Ranolazine.
abstract: Percutaneous coronary intervention and anti-anginal medications have similar prognostic effectiveness in patients with chronic stable angina. The choice of optimal medical therapy for the management of chronic angina is of pivotal importance in patients with stable ischemic heart disease. The most commonly used anti-anginal agents have demonstrated equivalent efficacy in improving patient reported ischemic symptoms and quantitative exercise parameters. With regards to mortality, beta-blockers are beneficial only in the setting of depressed left ventricular systolic function after a recent myocardial infarction. Recent evidence suggests the lack of any benefit of beta-blockers in patients with preserved systolic function, even in the setting of prior myocardial infarction.Ranolazine is a non-haemodynamic anti-anginal agent. It is effective as adjunctive therapy in patients with chronic stable angina whose symptoms are un-adequately controlled by conventional treatment. The clinical development program of ranolazine has shown that the drug improves exercise performance, decreases angina and use of sublingual nitrates, compared to placebo. Ranolazine is well tolerated with neutral effect on haemodynamics. Besides its role in chronic stable angina, ranolazine has the potential for development in a number of other cardiovascular and non-cardiovascular conditions in the future.
authors.affiliation: Clinical Academic Group, St George's Hospital NHS Trust, Cranmer Terrace, London, SW17 0RE, UK. grosano@sgul.ac.uk.|Cardiovascular and Cell Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK. grosano@sgul.ac.uk.|Department of Medical Sciences, IRCCS San Raffaele Roma, Via della Pisana, 235, 00163, Rome, Italy. grosano@sgul.ac.uk.
authors.forename: Giuseppe M C
authors.initials: GMC
authors.lastname: Rosano
authors.affiliation: Clinical Academic Group, St George's Hospital NHS Trust, Cranmer Terrace, London, SW17 0RE, UK.|Cardiovascular and Cell Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK.|Department of Medical Sciences, IRCCS San Raffaele Roma, Via della Pisana, 235, 00163, Rome, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Vitale
authors.affiliation: Cardiovascular and Cell Sciences Research Institute, St George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Volterrani
mesh_terms: D060050:Angina, Stable / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D000818:Animals; D002317:Cardiovascular Agents / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D000069458:Ranolazine / Q000493:pharmacokinetics / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D002317:Cardiovascular Agents; D000069458:Ranolazine
keywords: Angina; Coronary artery disease; Heart; Heart failure; Ivabradine; Myocardial infarction; Prognosis; Ranolazine; Trimetazidine