Ranolazine effectively controls chest pain in patients with type 2 diabetes mellitus

This study assessed the efficacy and safety of ranolazine (Ranexa) for the treatment of angina in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD).

Stable angina (or angina pectoris), is a type of chest pain or discomfort that usually occurs with physical activity or stress due to poor blood flow through the blood vessels in the heart. This reduces the blood supply and oxygen to the heart muscle, also known as cardiac ischemia. The most common cause of stable angina is CAD (damage to the main blood vessels that supply blood and oxygen to the heart). T2DM is a major risk factor of developing CAD. Patients with T2DM and CAD generally have recurrent episodes of angina that interfere with their normal activities. Ranolazine is a drug prescribed for the treatment of chronic (long term) angina, alone or in combination with other anti-angina drugs (such as nitroglycerin). It is also believed that ranolazine can lower blood sugar levels in patients with diabetes mellitus. Since patients with CAD and T2DM generally have more severe angina, which is more difficult to control, the aim of this study was to evaluate the efficacy of ranolazine in this group of patients. 

This study included 927 T2DM patients with angina. Patients were randomly assigned to receive for 8 weeks either ranolazine (462 patients) or a placebo, a substance with no medical effect, used as a control when testing new drugs (465 patients). All patients have been previously treated with one or two anti-angina drugs. After 8 weeks of treatment, patients in the ranolazine group had an average frequency of 3.8 weekly angina events as compared to 4.3 events in the placebo group. Also, average weekly doses of nitroglycerin were 1.7 in patients under ranolazine treatment and 2.1 in the placebo group. There was no difference in frequency of side effects between the 2 treatment groups.

In summary, ranolazine effectively reduced angina episodes and nitroglycerin use in patients with T2DM with chronic stable angina.

This study is limited by the short treatment and follow up period. Future studies with longer treatment duration are needed to confirm the long-term effects of ranolazine in T2DM patients and angina.

This study was funded by Gilead Sciences, the manufacturer of Ranexa.