Researchers from Syracuse Preventive Medicine, NY, USA discuss a new drug called ranolazine that has been deemed a safe and effective treatment for chronic stable angina. Drs Stephen Nash and David Nash discuss this new treatment option in a New Drug Class paper published in The Lancet.
Angina is characterized by severe chest pain caused by a lack of blood and oxygen supply to the heart muscle, often due to ischemic heart disease. A form of the condition called chronic stable angina is quite prevalent in developed nations. In the USA, a country where heart disease is the largest cause of death, about 9.1 million people (3% of the population) have chronic stable angina. The ratio of heart attack patients to angina patients in the USA is 1 to 30. Physicians have recommended several treatments for angina, including β blockers, statins, aspirin, and changes in diet and exercise. In 2006, ranolazine was approved for use for patients with angina who do not seem to respond to any of the typical courses of treatment.
Several randomized controlled clinical trials (MARISA, CARISA, ERICA, among others) have been instrumental in assessing ranolazine. The trials also demonstrated that the drug allowed patients to exercise for longer periods of time before the development of another angina attack. Further, ranolazine reduced anginal episodes by about one attack per week. Although women have a higher prevalence of angina than men, men received more of an exercise benefit than women given the drug. The studies reported that nausea, constipation, and dizziness could result as side effects. At US$207 to $413 for a 30-day regimen, researchers still questioned whether or not the drug was cost-effective. “Expense must be balanced against the cost of an alternative therapy. In chronic stable angina, the alternative is often an invasive revascularisation,” note the authors.
Nash and Nash conclude that: “Ranolazine seems to be a safe addition to current traditional drugs for chronic stable angina, especially in aggressive multidrug regimens…physicians in practice understand that lifestyle changes, including a low-fat diet with low cholesterol, a near-vegetarian diet, a regular exercise programme with excellent compliance, and a programme of stress-reduction measures are important in the treatment and prevention of angina. Studies of combinations of these lifestyle changes have shown efficacy in reducing the symptoms of chronic stable angina. Combination of such interventions with the use of ranolazine should be studied in carefully designed controlled trials, and almost certainly will be. The future outlook for patients with chronic stable angina should then be brighter.”
Ranolazine for chronic stable angina
D T Nash, S D Nas
The Lancet (2008). 372[9646]: pp. 1335 – 1341.
Written by: Peter M Crosta