Ranolazine: Drug overview and possible role in primary microvascular angina management

Cattaneo, M.; Porretta, Alessandra Pia; Gallino, Augusto

doi:10.1016/j.ijcard.2014.12.055

Cited by 31 publications

(19 citation statements)

References 42 publications

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“…β-Blockers might be preferred in patients with evidence of increased adrenergic activity 1 . Ranolazine has been suggested to reduce mechanical compression of coronary microcirculation 94,95 . In addition, ranolazine might also improve coronary self-regulation 96 .…”

Section: Microvascular Anginamentioning

confidence: 99%

A 'diamond' approach to personalized treatment of angina

et al. 2017

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Chronic stable angina pectoris is the most prevalent symptomatic manifestation of ischaemic heart disease, and its management is a priority (BOX 1). Current clinical guidelines recommend antianginal therapy to control symptoms, before considering coronary artery revasculariza tion [1][2][3][4] . However, revascularization by either percutaneous coronary angioplasty or CABG surgery is indicated in patients who have significant artery steno sis (50% left main narrowing or proximal three-vessel disease) to reduce myocardial ischaemia and its adverse clinical manifestation. Antianginal agents are approved by documenting that they improve total exercise duration, together with a reduction in daily frequency of chronic stable angina compared with placebo and/or equivalence to an active comparator. Cardiovascular outcomes, although highly advocated, are not a pre requisite for regulatory approval. None of the antianginal drugs has been proved to reduce cardiovascular mortality or the rate of myocardial infarction. When patients are optimally treated, mortality for chronic stable angina is low, which might explain why all trials designed to improve prognosis have been negative. Guidelines recom mend a first-choice and a second-choice approach, based more on tradition and expert opinion, rather than evidence. This categorical approach has been questioned in the past couple of years 5-8 . Newer antianginal drugs, which are classified as second choice, have more evidence-based clinical data that are more contemporary to support their use than is available for the traditional first-choice drugs. Equally, the often-needed combin ation of double or triple therapy is based on expert opinion and not related to the underlying pathophysio logy. What constitutes optimal antianginal treatment, therefore, varies considerably between countries, and the majority of doctors treat their patients according to their own preconceptions.A group of experts with experience and interest in chronic stable angina met at the University of Ferrara, Italy, to discuss an individualized approach to medical treatment of chronic stable angina, on the basis E X P E RT C O N S E N S U S D O C U M E N TA 'diamond' approach to personalized treatment of angina Abstract | In clinical guidelines, drugs for symptomatic angina are classified as being first choice (β-blockers, calcium-channel blockers, short-acting nitrates) or second choice (ivabradine, nicorandil, ranolazine, trimetazidine), with the recommendation to reserve second-choice medications for patients who have contraindications to first-choice agents, do not tolerate them, or remain symptomatic. No direct comparisons between first-choice and second-choice treatments have demonstrated the superiority of one group of drugs over the other. Meta-analyses show that all antianginal drugs have similar efficacy in reducing symptoms, but provide no evidence for improvement in survival. The newer, second-choice drugs have more evidence-based clinical data that are more contemporary than is available for tr...

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Section: Microvascular Anginamentioning

confidence: 99%

A 'diamond' approach to personalized treatment of angina

et al. 2017

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“…Extended-release ranolazine has been well tolerated in both short-term and long-term data sets. 15 In 746 patients followed during a mean follow-up of 2.82 years, the most frequent adverse events reported were dizziness (11.8%), constipation (10.9%), and peripheral edema (8.3%). 16 Plasma levels increase up to 50% to 60% in patients with moderate hepatic or renal impairment.…”

Section: Tolerabilitymentioning

confidence: 99%

“…Although the long-term prognosis of patients with stable MVA is not as poor as patients with obstructive CAD, 36 patients often have an impaired quality of life due to persistent angina. 15 Treatment typically consists of standard anti-anginal medications including b-blockers and calcium channel blockers; however, 20% to 30% of patients remain symptomatic. 15 There is evidence that ranolazine may reduce mechanical compression of coronary microcirculation and thus improve mechanical dysfunction.…”

Section: Microvascular Coronary Dysfunctionmentioning

confidence: 99%

“…15 Treatment typically consists of standard anti-anginal medications including b-blockers and calcium channel blockers; however, 20% to 30% of patients remain symptomatic. 15 There is evidence that ranolazine may reduce mechanical compression of coronary microcirculation and thus improve mechanical dysfunction. 37,38 Multiple techniques exist to evaluate microvascular function including coronary flow reserve using invasive testing and myocardial perfusion reserve using positron emission tomography or cardiac magnetic resonance imaging.…”

Section: Microvascular Coronary Dysfunctionmentioning

confidence: 99%

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Ranolazine: A Contemporary Review

Rayner-Hartley

Sedlak

2016

JAHA

262

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“…Тем не менее, прием β-блокаторов может считаться предпочтительным при наличии признаков повышенной активности симпатического отдела вегетативной нервной системы [27]. Предполагалось, что прием ранолазина может уменьшать компрессию микрососудов сердца [68] и улучшать ауторегуляцию коронарного сосудов [69]. Однако в ходе выполнения двойного слепого плацебо-контролируемого перекрестного РКИ, включавшего женщин со стенокардией напряжения при отсутствии обструктивного поражения КА, прием ранолазина в целом не приводил к статистически значимому про-тивоишемическому эффекту, за исключением отдельных больных со сниженным резервом коронарного кровотока [70].…”

Section: микрососудистая стенокардияunclassified

Modern strategy of treating patients with coronary artery disease: complementarity principle in therapy and new ideas about its role and components

2019

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В статье рассматриваются современные представления о роли механической реваскуляризации миокарда и лекарственной противоишемической терапии в лечении больных со стабильным течением ишемической болезни сердца (ИБС). Приводятся современные данные о сравнительной эффективности противоишемических препаратов, которые стали основанием для разработки концепции "бриллиантового подхода" к лечению больных со стабильным течением ИБС, которая предлагается вместо стандартной тактики с использованием иерархического подхода к выбору противоишемических средств. Рассматриваются особенности применения противоишемических препаратов в определенных клинических ситуациях, у больных с наиболее распространенными сопутствующими заболеваниями или осложнениями ИБС, а также при вариантах ИБС, в развитии которых играют роль специфические патофизиологические звенья. Ключевые слова: ишемическая болезнь сердца, тактика лечения, механическая реваскуляризация. Конфликт интересов: не заявлен.

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Ranolazine: Drug overview and possible role in primary microvascular angina management

Cited by 31 publications

References 42 publications

A 'diamond' approach to personalized treatment of angina

A 'diamond' approach to personalized treatment of angina

Ranolazine: A Contemporary Review

Modern strategy of treating patients with coronary artery disease: complementarity principle in therapy and new ideas about its role and components

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