The drug Ranexa (ranolazine) may help reduce chest pain in people with type 2
diabetes, a new study finds.
The drug is approved in the United States for treatment of chronic angina
(chest pain), but this is the first study to evaluate it in patients with
diabetes, heart disease and angina, according to the researchers.
One expert not connected to the study said the findings are welcome news for
The study "demonstrates that ranolazine is very effective in reducing angina
in those with type 2 diabetes and, interestingly, is more effective in those
with higher blood sugars," said Dr Howard Weintraub, clinical associate
professor in the department of medicine at NYU Langone Medical Center in New
People with diabetes are at increased risk for heart disease, and people with
heart disease and diabetes are more likely to have angina than those without
diabetes, the researchers noted.
How the study was done
The study included more than 900 patients who received either 1 000
milligrammes of Ranexa or an inactive placebo twice a day for eight weeks. The
patients had type 2 diabetes, heart disease and at least one angina episode a
week, and were already taking one or two other anti-angina drugs.
Between weeks two and eight of the study, patients taking Ranexa had an
average of 3.8 angina episodes per week, compared with 4.3 episodes per week for
those taking the placebo.
Patients taking the drug used 1.7 doses of nitroglycerin per week, compared
with 2.1 doses per week among those in the placebo group.
Nitroglycerin is commonly used to treat or prevent episodes of chest pain in
people who have coronary artery disease (narrowing of the blood vessels that
supply blood to the heart).
The study was scheduled for presentation at the annual meeting of the
American College of Cardiology in San Francisco. It was also published online
the same day in the Journal of the American College of Cardiology and
will appear in the journal's May issue.
What the study found
"Angina is associated with worse quality of life, increased risk of
hospitalisation and higher health care costs, and appears to be more prevalent
in patients with diabetes," study lead author Dr Mikhail Kosiborod, associate
professor of medicine at the University of Missouri, Kansas City, and a
cardiologist at St Luke's Mid America Heart Institute, said in a meeting news
"While ranolazine was shown to be effective in reducing angina in prior
studies, this is the first time it has been prospectively evaluated in patients
with diabetes - a high-risk and therapeutically challenging group," he
The study also found that Ranexa had the strongest effect in reducing angina
episodes among patients with poor blood sugar control. Prior research has shown
that the drug may lower fasting glucose levels in people with diabetes.
"Ranolazine is an effective anti-anginal drug in patients with diabetes and
may also have a glucose [blood sugar]-lowering effect," Kosiborod said. "If the
glucose-lowering action of ranolazine is confirmed in future studies, patients
with diabetes and angina may derive a dual benefit from this drug."
Weintraub agreed. "As the focus of the treatment of angina in diabetics
increasingly focuses on [drug] therapy, this may offer another choice in optimal
medical care in this group of patients," he said.
The majority of the study patients were men (61%). 96% had high blood
pressure and 74% had a history of heart attack. Most patients were taking
cholesterol-lowering statins (82%) and heart drugs such as ACE inhibitors (88%).
16% were smokers.
About 347 million people worldwide have diabetes and about 90% of those
people have type 2 diabetes. The main causes of type 2 diabetes are believed to
be excess weight and lack of physical activity.
One in three American adults could have the condition by the year 2050,
according to the US Centers for Disease Control and Prevention.
The US National Institute of Diabetes and Digestive and Kidney Diseases has
more about diabetes.
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