Management Options in Chronic Stable Angina Pectoris: Focus on Ranolazine

摘要: Chronic stable angina pectoris results from a fixed coronary arterial obstruction causing an imbalance between myocardial oxygen supply and demand. Current therapy aims to reduce cardiovascular events (vasculoprotective) thereby improving survival, and/or relieve ischemic symptoms (antianginal) the quality of life. Vasculoprotective consists lifestyle modification, antiplatelet agents, lipid lowering angiotensin-converting enzyme (ACE) inhibitors. Conventional antianginal for patients with chronic beta-blockers, calcium channel blockers nitrates, surgical or percutaneous revascularization serving adjunctive role. Despite investigation multiple novel therapies medications over past 25 years, arguably most significant contribution during that time involved recent introduction ranolazine. Ranolazine acts via distinctive pathway, inhibiting late sodium current action potential in myocytes. Multiple studies have demonstrated ranolazine significantly reduces anginal improves exercise performance but does not mortality. affect either heart rate blood pressure, unique property among agents. its QT prolongation, has proven safety profile is proarrhythmic. In fact, large randomized trial, reduced incidence supraventricular tachycardia, ventricular new-onset atrial fibrillation bradycardic events. may confer some additional benefits such as reduction HbA1c levels improved left diastolic function. now approved use angina. guidelines recommend beta-blockers first line agent due mortality reduction. However, bradycardia hypotension, be considered initial therapy.