A new drug ranolazine is a safe and effective treatment for chronic stable angina and adds to the treatment options for patients with this condition. The treatment is discussed in a New Drug Class paper in this week's edition of The Lancet, written by Drs Stephen Nash and David Nash, Syracuse Preventive Medicine, NY, USA.
Heart disease continues to be the largest cause of death in the USA, and chornic stable angina is very prevalent in developed nations – in the USA, 9.1 million people have the condition, some 3% of the population. For every patient admitted to hospital with a heart attack, there are 30 angina patients. There are a wide variety of angina treatments including β blockers, statins, aspirin, and diet and exercise. Ranolozine was patented in 1986, and then approved for use in the USA in 2006 for angina patients who remain symptomatic despite being on one or more of the standard treatments above.
Ranolazine has been assessed in randomised controlled trials (MARISA, CARISA, ERICA among others), and extended the time patients could exercise before an angina attack developed. It also redued anginal episodes by a mean of one attack per week. Men showed more of an exercise benefit than women given the drug, this despite a higher prevalence of angina in women than men. Side-effects of the drug can be nausea, constipation, and dizziness. Questions remain over the cost-effectiveness of the drug – at US$207 to $413 for a 30-day course, it can be considered expensive. But the authors say: "Expense must be balanced against the cost of an alternative therapy. In chronic stable angina, the alternative is often an invasive revascularisation."
The authors conclude: "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."
Drs David Nash and Stephen Nash, Syracuse Preventive Medicine, NY, USA T) +1 315-382-2304 / +1 315-475-9921 E) davidtnash@aol.com
Full New Drug Class paper: http://press.thelancet.com/angina.pdf
Journal
The Lancet