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Improved Quality of Life with Ranolazine

Jun 13, 2014

Patients with diabetes and stable angina may reap the benefits of ranolazine…. 

Based on the Type 2 Diabetes Evaluation of Ranolazine in Subjects with Chronic Stable Angina (TERISA) trial, ranolazine was found to reduce angina occurrences and the use of nitroglycerin on type 2 diabetes mellitus (T2DM) and stable angina patients. Based on the same trial, the study also looked into the effects of improvement in quality of life and health for patients with these morbidities.

TERISA was a randomized, double-blind, placebo-controlled trial that covered 14 countries in which patients with chronic stable angina and T2DM were randomized to placebo or ranolazine treatment group. The dosing schedule was 1000mg twice daily for 8 weeks. Overall, 917 patients were randomized. The population consists of a mean age of 64, 61% men, 99% white, and mean A1c levels of 7.3%. Health status and quality of life was assessed with the Seattle Angina Questionnaire (SAQ), Rose Dyspnea Scale, and the Medical Outcomes Short Form-36 (SF-36) component scores. Scores were compared using analysis of covariance.

Overall when compared with placebo, the ranolazine group had less angina frequencies, improved treatment satisfaction, and improved SF-36 physical component scores. The SF-36 mental component scores improved more with the ranolazine treatment group as well (p value .009). Patients treated with ranolazine had a 10-point improvement in the SAQ angina scores frequency scores when compared with the placebo group (67% vs 58%, p-value=.004). In essence, 1 in 11 patients need to be treated with ranolazine to see a significant difference in improvement of angina.

TERISA had some limitations in terms of the patient population that was majority white. The study may also have been underpowered as well, which may lead to potential type II error. Nonetheless, ranolazine has shown to improve a patient’s health status and quality of life in patients with T2DM and stable angina. A greater portion of those patients experiencing more anginas and taking more anti-anginal medications reaps more of the benefits with ranolazine as a treatment regimen.

Practice Pearls:
  • Ranolazine reduces frequency of angina episodes and use of sublingual nitroglycerin in patients with type 2 diabetes and chronic stable angina.
  • Patients witness an improved quality of life and health when taking ranolazine
  • Patients who have severe angina and are taking multiple anti-anginal medications will see more distinct outcomes with ranolazine.

Arnold SV, Kosiborod M, McGuire DK, et al. Effects of Ranolazine on Quality of Life Among Patients with Diabetes Mellitus and Stable Angina. JAMA Internal Medicine. 4 June 2014