OUP user menu

Effects of ranolazine on exercise tolerance and HbA1c in patients with chronic angina and diabetes

Adam D. Timmis, Bernard R. Chaitman, Michael Crager
DOI: http://dx.doi.org/10.1093/eurheartj/ehi495 42-48 First published online: 21 September 2005

Abstract

Aims The anti-anginal efficacy and safety of ranolazine in diabetic and non-diabetic patients included in the Combination Assessment of Ranolazine In Stable Angina (CARISA) trial (JAMA 2004;291:309) were studied. Glycaemic control was also assessed in CARISA and its long-term open-label extension study.

Methods and results Patients with chronic angina enrolled in CARISA (189 with diabetes, 634 without diabetes) on background atenolol, diltiazem, or amlodipine therapy were randomized to placebo, ranolazine 750 or 1000 mg twice daily for 12 weeks, during which exercise tolerance, angina frequency, nitroglycerin usage, glucose, HbA1c, and lipids were measured. Patients completing the randomized study could enroll in an ongoing open-label extension study and were evaluated every 3 months. Ranolazine produced similar improvements in exercise parameters, nitroglycerin use, and angina frequency in diabetic and non-diabetic patients. Adverse events were similar between groups. Fasting glucose and lipids remained unaltered in diabetic patients after 12 weeks of therapy. In a post hoc analysis, ranolazine 750 and 1000 mg reduced HbA1c vs. placebo by 0.48±0.18% (P=0.008) and 0.70±0.18% (P=0.0002), respectively; the HbA1c levels appeared to remain unchanged over time during long-term therapy.

Conclusion Anti-anginal efficacy and safety of ranolazine for angina were similar between diabetic and non-diabetic patients. Ranolazine significantly improved glycaemic control in diabetic patients.

  • Ranolazine
  • Diabetes
  • CARISA
  • Chronic stable angina
  • HbA1c

See page 5 for the editorial comment on this article (doi:10.1093/eurheartj/ehi624)

Introduction

Type 2 diabetes and the metabolic syndrome have reached epidemic levels in the United States1 and Europe, and are expected to result in an increased prevalence of cardiovascular disease.2 Diabetes is a significant predictor of cardiovascular mortality3 and is a common co-morbidity in angina patients. It has a reported prevalence of 7.9% in North America and 7.8% in Europe.4 The Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) of the National Cholesterol Education Program classifies diabetes as a coronary heart disease risk equivalent.5 Cardiovascular death and myocardial infarction rates are significantly increased in diabetic patients. Treatment options are often challenging because of the metabolic abnormalities that affect endothelial function and frequently co-morbid conditions, such as hypertension, dyslipidaemia, autonomic dysfunction, and extracardiac atherosclerosis.3,6

Ranolazine is a novel haemodynamically neutral anti-anginal and anti-ischaemic compound under development. Unlike existing anti-anginal agents, ranolazine studies have shown that its anti-anginal effect is achieved with little effect on blood pressure or heart rate.710 Ranolazine increases exercise capacity and reduces angina attacks in patients with chronic stable angina.7,8 Ranolazine was well tolerated with little or no effect on mean blood pressure or heart rate and induced an average increase in the QTc interval of <10 ms at 1000 mg twice daily in humans.7,8

We previously reported that in the placebo-controlled, multicentre, randomized Combination Assessment of Ranolazine in Stable Angina (CARISA) trial, ranolazine was effective in increasing treadmill exercise time, time to angina onset, and time to onset of ischaemic ST-segment depression in patients with chronic angina who had demand-induced myocardial ischaemia at low-level exercise workloads. The purpose of this analysis of the combination therapy trial was to evaluate the anti-anginal efficacy and adverse event profile of ranolazine in diabetic vs. non-diabetic patients with chronic angina. In addition, the effects of ranolazine on HbA1c levels, serum glucose, and serum lipid levels during the randomized phase of the CARISA trial and HbA1c values during its long-term open-label extension study were examined in diabetic patients to determine if ranolazine had specific effects on patients with diabetes.

Methods

Study design

The details of the CARISA trial have been previously described.7 Briefly, in the CARISA trial, 823 patients with chronic angina on background once daily atenolol (50 mg), diltiazem (180 mg), or amlodipine (5 mg) were randomized to 12 weeks of therapy in a three-arm parallel study to placebo, ranolazine 750 mg twice daily or ranolazine 1000 mg twice daily. As previously described, patients were randomized in 1:1:1 ratio to the three treatment groups in blocks of six, stratifying by background therapy.

At the screening and qualifying visits and subsequent visits at Weeks 2, 6, and 12, blood pressure, heart rate, and electrocardiogram (ECG) and exercise tolerance test (ETT) trough measurements, adverse events, and concomitant medication usage were collected as well as angina and nitroglycerin-use diary review. ECG and ETT peak measurements were evaluated at the screening and qualifying visits and Weeks 2 and 12. Physical exam, body weight and inclusion/exclusion criteria assessments, and laboratory tests (including HbA1c in diabetic patients), were conducted at the screening/qualifying visit and Week 12 (trial endpoint).

Upon successful completion of CARISA, patients who met entry criteria were eligible to participate in an open-label extension trial, which is ongoing. The extension trial analyses presented here were based on data availability through August 2003 and represent the results from ∼2 years of an anticipated 6-year study.

Study population

This analysis compared the effects of ranolazine in diabetic and non-diabetic patients (taking insulin or not taking insulin) enrolled in CARISA. To be eligible for CARISA, all patients were required to have chronic angina >3 months and documented coronary artery disease. Patients with a resting ECG abnormality that precluded analysis of the exercise ECG were excluded, as were patients who required digoxin therapy, were in New York Heart Association (NYHA) class III or IV failure, or had an acute coronary syndrome or revascularization procedure within 2 months before study entry. Diabetes was diagnosed on the basis of clinical history with no requirement for ongoing treatment with hypoglycaemic agents. Insulin-dependent diabetics were designated as such for analysis if they were receiving insulin treatment at baseline.

As previously described,7 the qualifying criterion for randomization was based on exercise duration with two modified Bruce ETTs, 1 week apart, such that the presence of exercise-induced angina was achieved. Ischaemic ST-segment depression ≥1 mm was validated at St Louis University Core ECG Laboratory.

Efficacy assessments

The primary efficacy parameter in CARISA was the exercise duration at 12 h post-dose, which is the approximate time of trough ranolazine plasma concentrations. Exercise testing was also performed at the peak time of plasma concentrations, ∼4 h post-dose. The ETT time required to reach the severity of symptoms that would typically have caused the patient to stop exercise during the course of his or her usual daily activities (and no further) constituted the ‘exercise duration’ endpoint of the study. Secondary efficacy variables included time to onset of angina, time to ≥1 mm ST-segment depression, and patient-reported frequency of angina attacks and nitroglycerin consumption. HbA1c was assessed post hoc as a measure of efficacy in patients with diabetes.

Safety analyses

Adverse events were recorded and investigators assessed the drug relationship of each event.

Laboratory measures

The protocol specified that laboratory values were to be collected 12 h (±0.5 h) after patients' most recent dose of study medication and following a 10–12 h fasting period from the previous evening. Key laboratory tests included ECGs, haematology, coagulation, serum chemistry (HbA1c in diabetic patients only; HbA1c was not collected in patients who were not diabetic at baseline), urinalysis, and lipid panel. HbA1c was analysed by Covance Central Laboratory using Bio-Rad Variant analyser that utilizes ion-exchange high performance liquid chromatography. In this analysis, the safety of ranolazine in diabetic vs. non-diabetic patients was compared through evaluation of adverse events, vital signs, and laboratory data.

Statistical considerations

Within CARISA, the effects of ranolazine on exercise time variables in diabetic vs. non-diabetic patients were assessed in an analysis of covariance (ANCOVA) model with effects for treatment, baseline exercise time, background therapy (atenolol, diltiazem, or amlodipine), centre (pooled by geographic region), diabetes status, and the interaction of treatment with diabetes status, using the last observation carried forward after randomization. The primary analysis data set included all patients who received study drug and had at least one evaluable ETT after randomization, assigning patients to treatment groups as randomized with intention to treat. Angina frequency and nitroglycerin consumption were normalized by time of study participation and expressed as a weekly rate. The weekly rates were ranked and analysed using the ANCOVA model described earlier.

For the diabetic patients in CARISA, change from baseline in HbA1c at 12 weeks of treatment or early termination was analysed post hoc using an ANCOVA model with effects for treatment, baseline laboratory value, pooled site, and background therapy. Treatment effects in diabetic patients who were taking insulin and those who were not were estimated by adding insulin status and the interaction of treatment with insulin status to this ANCOVA model. The proportion of patients with HbA1c <7% at 12 weeks of treatment or early termination was analysed using a logistic regression model with the same effects as the main ANCOVA model. Early termination was defined as failure of the patient to complete 12 weeks of randomized therapy during the double-blind study.

Combining data from the diabetic patients in CARISA and the long-term extension trial who received ranolazine, changes from baseline HbA1c were summarized as a function of time since start of ranolazine. Patient data for the long-term study were included if patients did not have more than a 7-day interruption in dosing between CARISA and its long-term extension study. For this analysis, the time scale was broken into 100-day intervals. The average value of HbA1c in each of these intervals was estimated with a repeated measures generalized estimating equations (GEE) model11 using the normal distribution and with effects for baseline value and time, insulin use, and the interaction of time with insulin use. Assuming that the duration of each patient's study participation is not correlated with HbA1c, this method provides an unbiased estimate of the changes in HbA1c over time, appropriately adjusting for missing data. Diagnostic tests using GEE models showed no evidence for correlation between the duration of follow-up and the observed values of HbA1c (P>0.53). A sensitivity analysis comparing the results in all patients with those patients who had the longest follow-up was also used to validate the repeated measures analysis.

All hypothesis tests were two-sided and conducted at the 0.05 level of significance. The analyses reported are exploratory and as such there was no adjustment for multiple inferences.

Results

Patients

Of the patients enrolled in CARISA, 189 (23%) had a history of diabetes. Baseline characteristics of the diabetic and non-diabetic patients in the CARISA trial are illustrated in Table 1, including the antidiabetic medications taken by the diabetic patients.

View this table:
Table 1

Baseline demographics of diabetic vs. non-diabetic patients

CharacteristicDiabeticNon-diabetic
Patients, n (%)189 (23)634 (77)
Age, years (mean±SE)   65±0.6 64±0.4
Men, n (%)136 (72)501 (79)
Prior MI, n (%)113 (60)361 (57)
Prior CABG, n (%)43 (23)101 (16)
Prior PCI, n (%)51 (27)101 (16)
History of hypertension, n (%)140 (74)387 (61)
CHF (NYHA class I or II), n (%)55 (29)190 (30)
Diabetic patients receiving concomitant medicationsa
Medication drug classPlacebo n (%) (n=57)Ran 750 mg n (%) (n=68)Ran 1000 mg n (%) (n=64)
Diabetics receiving any antidiabetic medication39 (68.4)42 (61.8)46 (71.9)
α-Glucoside inhibitors2 (3.5)1 (1.5)1 (1.6)
Secretegogues19 (33.3)32 (47.1)31 (48.4)
Thiazolidinediones1 (1.8)3 (4.4)1 (1.6)
Biguanides16 (28.1)17 (25.0)19 (29.7)
Insulin11 (19.3)13 (19.1)11 (17.2)
Calcium dobesilate01 (2.3)0

CABG, coronary artery bypass graft; CHF, congestive heart failure; MI, myocardial infarction; PCI, percutaneous coronary intervention; SE, standard error; Ran, ranolazine.

aPatients could be receiving more than one medication.

Efficacy

As previously reported in the CARISA study,7 ranolazine significantly improved exercise duration in the primary analysis of the overall population. Figure 1 shows the effects of ranolazine on exercise duration (primary efficacy parameter), time to onset of angina, and time to ≥1 mm ST-segment depression at trough plasma concentrations in diabetic and non-diabetic patients in this study. The treatment effects appear to be similar in the two subgroups. There was no significant treatment by subgroup interaction for exercise duration (P=0.89), time to onset of angina (P=0.54), or time to ≥1 mm ST-segment depression (P=0.44), and therefore no evidence that the treatment effect differed between diabetic and non-diabetic patients. At the time of peak ranolazine plasma concentrations, there was also no evidence that the treatment effect differed between diabetic and non-diabetic patients. At peak (data not shown), there was no significant treatment by subgroup interaction for exercise duration (P=0.58), time to onset of angina (P=0.26), or time to ≥1 mm ST-segment depression (P=0.088).

Figure 1 Change from baseline in CARISA in (A) exercise duration, (B) time to onset of angina, and (C) time to ≥1 mm ST-segment depression at trough.

Over the 12 weeks of the CARISA trial, ranolazine significantly reduced the number of normalized weekly angina episodes and nitroglycerin usage in the overall patient population.7 The effects of ranolazine in diabetic patients and in non-diabetic patients appear to be similar, as shown in Figure 2. Statistical tests for interaction between diabetes status and treatment effect showed no evidence that the effect of ranolazine differed between diabetic and non-diabetic patients in either the number of weekly angina episodes (P=0.81) or nitroglycerin usage (P=0.063). It appears that the effects of ranolazine in diabetic patients are comparable to those in non-diabetic patients.

Figure 2 Normalized (A) weekly angina episodes and (B) nitroglycerin use in diabetic vs. non-diabetic patients.

Effect of ranolazine on HbA1c in diabetic patients

HbA1c values were obtained from 160/189 (85%) of diabetic patients at baseline and 140/189 (74%) of diabetic patients at 12 weeks. The analysis of HbA1c changes from baseline included the 131 (69%) patients who had both baseline and on-treatment HbA1c values. The analysis adjusted the estimated end-of-treatment and change-from-baseline mean values for baseline differences among the treatment groups. As shown in Table 2, ranolazine 750 and 1000 mg reduced HbA1c compared with placebo by 0.48±0.18% (P=0.008) and 0.70±0.18% (P=0.0002), respectively. When the diabetic patients in CARISA were stratified by insulin treatment, the reduction in HbA1c compared with placebo in those receiving insulin was greater, as shown in Table 3.

View this table:
Table 2

Effect of ranolazine on HbA1c (%) in diabetic patients (least-squares mean±SEM)

Placebo (n=37)Ranolazine 750 mg BID (n=47)Ranolazine 1000 mg BID (n=47)
Baselinea7.46±0.217.65±0.207.92±0.21
Week 12 or early terminationb7.62±0.147.14±0.136.93±0.13
Change from baselineb−0.02±0.14−0.50±0.13−0.72±0.13
Difference vs. placebo−0.48±0.18 (P=0.008)−0.70±0.18 (P=0.0002)

aLeast-squares mean estimates from analysis of variance with effects for treatment, pooled centre, and background therapy.

bLeast-squares mean estimates from analysis of covariance with effects for treatment, pooled centre, background therapy, and baseline HbA1c.

View this table:
Table 3

Effect of ranolazine on HbA1c (%) in insulin-treated vs. non-insulin-treated diabetic patients (least-squares mean±SE)

Placebo receiving insulinRanolazine 750 mg BID receiving insulinRanolazine 1000 mg BID receiving insulin
Yes (n=10)No (n=27)Yes (n=13)No (n=34)Yes (n=8)No (n=39)
Baselinea7.73±0.407.37±0.257.99±0.357.52±0.247.51±0.468.00±0.23
Week 12 or time of early terminationb8.06±0.267.45±0.167.23±0.237.10±0.157.01±0.306.90±0.15
Change from baselineb0.42±0.26−0.19±0.16−0.41±0.23−0.54±0.15−0.63±0.30−0.74±0.15
Difference vs. placebo−0.84±0.34 (P=0.016)−0.35±0.20 (P=0.087)−1.05±0.39 (P=0.008)−0.55±0.20 (P=0.007)

aLeast-squares mean estimates an analysis of variance model with effects for treatment, pooled centre, background therapy, insulin treatment, and the interaction between randomized treatment and insulin treatment.

bLeast-squares mean estimates an analysis of covariance model with effects for treatment, pooled centre, background therapy, insulin treatment, the interaction between randomized treatment and insulin treatment, and baseline HbA1c.

Recent diabetes treatment guidelines emphasize achieving a HbA1c of <7% as the target for the treatment of diabetes.12 Table 4 shows the percentage of diabetic patients in CARISA with an HbA1c of <7% at baseline and at the end of treatment. Using a logistic regression analysis that adjusted for baseline differences, the percentage of diabetic patients with HbA1c <7% was significantly higher in the ranolazine 1000 mg group (P=0.004). This change in HbA1c was not accompanied by an increase in weight during the 3-month double-blind period. Ranolazine did not appear to significantly lower fasting glucose concentrations during the 12-week treatment phase (Table 5).

View this table:
Table 4

Patients with HbA1c<7%

Placebo (n=37)Ranolazine 750 mg BID (n=47)Ranolazine 1000 mg BID (n=47)
Baseline, n (%)14 (37.8)17 (36.2)12 (25.5)
Week 12 or time of early termination, n (%)a16 (43.2)24 (51.1) (P=0.30 vs. placebo)26 (55.3) (P=0.004 vs. placebo)

aLogistic regression with effects for treatment, pooled centre, background therapy, and baseline HbA1c.

View this table:
Table 5

Incidence of adverse events occurring in ≥5% of any treatment group

Adverse event (%)Diabetic patientsNon-diabetic patients
Placebo (n=57)Ran 750 mg BID (n=68)Ran 1000 mg BID (n=64)Placebo (n=212)Ran 750 mg BID (n=211)Ran 1000 mg BID (n=211)
Patients with adverse events24.625.034.426.933.232.2
Discontinuations due to adverse events5.32.910.96.19.58.5
Angina5.34.41.64.23.83.3
Constipation02.99.40.97.66.6
Dizziness1.81.57.81.94.36.6
Nausea1.84.43.10.52.85.7
Asthenia01.57.82.81.93.8

In Figure 3, it appears that levels of HbA1c remained unchanged beyond 12 weeks of ranolazine treatment in the long-term, open-label extension study (for up to 2 years). The Day-50 point represents an average of all measurements taken at any time <100 days after the start of ranolazine during either CARISA or the long-term extension. For this analysis, data from all ranolazine-treated patients were combined, regardless of dose. A sensitivity analysis using only patients who had values in the latest time interval produced similar results.

Figure 3 Change from baseline in HbA1c levels over time in diabetic patients treated with ranolazine in the double-blind and open-label phase. Data include all patients treated with ranolazine.

Adverse events

As shown in Table 5, the proportion of patients with adverse events was similar between diabetic patients and non-diabetic patients. There were no notable differences in either laboratory values or vital signs in diabetic vs. non-diabetic patients.

Effect of ranolazine on serum lipid levels in diabetic patients

As shown in Table 6, ranolazine 1000 mg did not have an effect on lipids during the 12-week double-blind treatment period in CARISA, whereas the 750 mg dose was associated with an increase in low-density lipoprotein and total cholesterol. These disparate values suggest a spurious finding and thus do not appear to be of clinical significance.

View this table:
Table 6

Glucose and serum lipids at week 12 (Mean±SE)

ParameterDiabetic patientsNon-diabetic patients
PlaceboRanolazine 750 mg BIDRanolazine 1000 mg BIDPlaceboRanolazine 750 mg BIDRanolazine 1000 mg BID
Glucose, mg/dL baseline177.8±10.8168.9±8.0165.2±7.8105.4±1.5106.4±1.4103.7±1.1
Change from baseline, (n)1.2±7.1 (49)8.0±8.8 (63)1.7±7.2 (57)0.8±1.5 (186)1.0±1.3 (189)0.3±1.2 (189)
Total cholesterol, mg/dL baseline212.1±10.0190.0±4.5206.8±6.4213.9±3.3209.2±2.8210.1±3.2
Change from baseline, (n)−4.3±4.1 (51)15.7±3.3 (65)0.7±4.5 (58)−4.0±1.9 (199)13.1±2.4 (198)13.4±2.1 (197)
Triglycerides, mg/dL baseline233.0±56.8192.0±14.5196.7±17.5165.8±6.0167.0±6.3170.1±6.4
Change from baseline, (n)26.3±21.2 (51)21.2±13.5 (65)−7.3±9.3 (58)−3.1±4.8 (199)15.8±6.4 (197)2.3±5.5 (197)
LDL, mg/dL baseline122.9±5.6109.6±4.5126.6±5.6136.7±3.1131.2±2.7131.8±3.0
Change from baseline, (n)−5.3±3.9 (50)9.5±2.6 (55)−4.4±4.3 (56)−3.1±1.7 (192)7.9±2.2 (188)6.0±1.7 (186)
HDL, mg/dL baseline46.1±1.644.7±1.544.4±1.745.4±0.945.3±0.844.7±0.8
Change from baseline, (n)−0.1±0.9 (51)1.9±1.0 (65)5.0±0.8 (58)−0.3±0.5 (199)2.6±0.6 (197)3.2±0.6 (197)
HDL/LDL ratio baseline0.42±0.030.47±0.040.39±0.020.37±0.010.38±0.010.37±0.01
Change from baseline, (n)0.03±0.02 (50)−0.04±0.03 (55)0.06±0.02 (56)0.01±0.01 (192)0.01±0.01 (188)0.02±0.01 (186)

HDL, high-density lipoprotein; LDL, low-density lipoprotein.

Discussion

We previously reported the results of the CARISA trial whereby ranolazine was effective for treating chronic stable angina during 12 weeks of therapy in combination with atenolol, diltiazem, or amlodipine.7 In CARISA, ranolazine compared with placebo treatment significantly improved exercise duration, time to onset of angina, and time to 1 mm ST-segment depression. In addition, ranolazine treatment reduced angina frequency and nitroglycerine usage compared with placebo treatment. As patients with diabetes account for 15–25% of the population enrolled in clinical trials of chronic angina therapy,13 and diabetic patients accounted for 23% of those enrolled in the CARISA trial, we sought to evaluate the effects of ranolazine in this patient population. The adverse event profile and ECG effects (including prolongation of the QT interval) of ranolazine were extensively reviewed in both the CARISA and MARISA study publications.7,8

This analysis indicated that ranolazine improved exercise parameters similarly in diabetic and non-diabetic patients. Treatment with ranolazine significantly decreased HbA1c concentrations in diabetic patients. Ranolazine did not appear to be associated with a clinically significant change in serum lipids. The earliest time point that might show the full effect of a therapeutic intervention on HbA1c is 12 weeks.14 Therefore, CARISA was the first study of ranolazine in which the duration of double-blind treatment was long enough for HbA1c to reach a new equilibrium. The reduction in HbA1c was significant vs. placebo in diabetic patients whether or not they were treated with exogenous insulin. In particular, the decreases in HbA1c seen in insulin-treated patients were greater than those seen in non-insulin-treated patients. In view of this observation, it can be speculated that an increase in insulin sensitivity may at least in part account for this observation. The significant response in HbA1c that was observed following ranolazine treatment was equivalent to that expected with an oral antiglycaemic agent and thus represents a considerable potential for clinical benefit.1517

HbA1c has become a standard measure of long-term glycaemic control.18 Raised HbA1c has been shown to be correlated with an increased incidence of diabetic complications including myocardial infarction.13 Further, the UK Prospective Diabetes Study (UKPDS)1517 has demonstrated that aggressive reduction of HbA1c with intensive hypoglycaemic therapy is associated with a reduction in complications of diabetes in Type 2 diabetics. Target levels of HbA1c of <7% have thus been incorporated into a number of guidelines.12,19 Cardiologists have an increasing role in the management of diabetic patients because of the substantial co-morbidity of diabetes and ischaemic heart disease17 and as a consequence, HbA1c estimation is an integral part of cardiology practice. Although the changes in HbA1c levels were not accompanied by similar changes in glucose in this study, ranolazine may offer a further therapeutic option in the management of the diabetic patient with ischaemic heart disease.

HbA1c was not a pre-planned efficacy variable in the CARISA trial, which had angina as its primary focus. For this reason, neither the presence of diabetes nor usage of insulin or other antidiabetic medication was a stratification factor in the randomization. Although the analysis of HbA1c was exploratory, the apparent dose-response is indicative of an effect of therapy rather than an artifact. In addition, hypoglycaemic therapy was not strictly controlled, although few patients changed either the nature or the dose of their therapies during the study. Patient activity was also a possible confounding factor. However, the level of exercise demonstrated by Boule et al.20 to be required to reduce HbA1c to the extent seen in this study (three 45 min sessions of moderate aerobic exercise per week) would be unexpected in such an elderly angina population. HbA1c values from the long-term follow-up study have no concurrent placebo control, and are thus subject to potential biases due to time trends in patients' disease states, and the possibility of patients discontinuing for reasons that would correlate with future HbA1c values. Because the data that would be needed to determine the nature of such a correlation cannot be observed, the magnitude of this potential bias is unknown.

Conclusions

Improvements in exercise duration and decreases in angina frequency appeared similar between diabetic and non-diabetic patients treated with ranolazine. Adverse events were similar between diabetic and non-diabetic populations. In patients with diabetes, ranolazine significantly decreased HbA1c. The HbA1c concentrations appeared to remain consistent over time during long-term treatment. The results of this study suggest that ranolazine may be an effective and well-tolerated anti-anginal medication in diabetic patients with chronic angina. Further, prospectively designed studies are warranted to confirm the findings of this analysis.

Acknowledgement

This study was supported by CV Therapeutics Inc.

Conflict of interest: A.D.T. is a member of CV Therapeutics Europe Advisory Faculty. M.C. is an employee of CV Therapeutics Inc., which supported these studies. B.R.C. is a consultant to CV Therapeutics and has received research grant from CV Therapeutics.

References

View Abstract