Current ideas about the role of ranolazine in patients’ treatment with angina pectoris

Abstract

The article presents modern views on the role of the anti-ischemic agent, ranolazine, in the treatment of a wide range of patients with angina pectoris. It also provides data on a percentage increase in the number of patients with chronic coronary artery disease who need improved anti-ischemic therapy. The need to use alternative agents for the treatment of angina, which is highlighted in the article, is determined by a percentage increase in the number of elderly and senile patients with angina, as such patients often have concomitant diseases that limit the use of haemodynamic anti-ischemic agents. The authors consider various pathophysiological links in the development of myocardial ischemia, which may become the background for choosing a specific anti-ischemic agent. Amongst others, the article provides evidence data on the effectiveness of the usage of ranolazine in patients with angina pectoris and myocardial ischemia, but in the absence of coronary artery obstruction. The mechanisms of action of ranolazine, which determine both its anti-ischemic and pleiotropic effects, are discussed in detail. Special effects of ranolazine that may be beneficial for patients with coronary artery disease and clinically significant diastolic dysfunction are observed. This effect consisted of a positive effect of ranolazine on the left ventricular diastolic function. Data on the cost-effectiveness of the usage of ranolazine in the treatment of angina pectoris are provided. The antiarrhythmic action of ranolazine is considered separately. The article discusses the tolerability of ranolazine and its possible side effects. The all-round good tolerability and high safety of ranolazine in a wide range of patients with coronary artery disease are emphasized.