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Ranolazine Improves Angina in Patients with Heart Failure: Presented at AHA

By Jill Stein

CHICAGO, IL -- November 18, 2002 -- The partial fatty acid oxidation inhibitor ranolazine provides effective antianginal therapy in patients with a history of heart failure who remain symptomatic despite treatment with a beta blocker or calcium channel blocker, researchers announced here November 17 at the American Heart Association's 2002 Scientific Sessions.

Dr. Harvey White, from Green Lane Hospital, in Auckland, New Zealand, reported results in 823 chronic angina patients who remained symptomatic on diltiazem CD 180 mg qd, atenolol 50 mg qd, or amlodipine 5 mg qd, who were randomized to treatment with ranolazine 750 mg bid, ranolazine 1,000 mg bid, or placebo.

The trial excluded patients with New York Heart Association class III or IV.

"Treating the chronic angina patient who also has heart failure can be difficult, as negative haemodynamic effects often accompany traditional antianginal therapies," Dr. White observed. "Newer therapies, like partial fatty acid oxidation inhibitors, have shown potential utility for treating chronic angina with minimal effects on hemodynamics."

Ranolazine shifts myocardial energy production from fatty acid oxidation to the more oxygen-efficient glucose oxidation, he continued. Because ranolazine exerts its effect without affecting hemodynamics, it may prove especially useful in chronic angina patients with a history of heart failure.

Patients performed modified Bruce treadmill tests at baseline and at weeks 2, 6, and 12 at trough and peak plasma levels. Overall, 237 patients had a prior history of class I or II heart failure.

Results showed that ranolazine prolonged exercise duration at trough and peak plasma levels. Similar results were seen in the time to angina and time to 1 mm ST segment depression. Also, ranolazine reduced the frequency of angina episodes.

While ranolazine's effects did not differ significantly in heart failure and non-heart failure patients (p>0.22), heart failure patients treated with ranolazine 750 mg had smaller improvements in all exercise measures at trough levels.

Ranolazine was well tolerated in patients with and without heart failure.

Dr. White said the results suggest that ranolazine is a potentially effective antianginal drug for patients with a history of heart failure who have symptoms despite treatment with a beta blocker or calcium antagonist.

The study was sponsored by CV Therapeutics in Palo Alto, California, United States.

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