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January 21, 2004

Ranolazine and Other Antianginal Therapies in the Era of the Drug-Eluting Stent

Author Affiliations

Author Affiliations: Division of Cardiovascular Diseases, Duke University Medical Center, and Duke Clinical Research Institute, Durham, NC.

JAMA. 2004;291(3):365-367. doi:10.1001/jama.291.3.365

In this issue of THE JOURNAL, Chaitman and colleagues1 report the results of the Combination Assessment of Ranolazine In Stable Angina (CARISA) trial, an important study evaluating ranolazine, a new antianginal drug. Ranolazine is the first member of a new class of drugs believed to reduce angina by partially inhibiting fatty acid oxidation, thereby increasing glucose oxidation and generating more ATP (adenosine triphosphate) per molecule of oxygen consumed.2,3 In the Monotherapy Assessment of Ranolazine In Stable Angina (MARISA) trial, an earlier placebo-controlled, double-blind trial of the same drug, ranolazine reduced angina and objective evidence of ischemia among patients who were taking no other antianginal medications.4 In CARISA, ranolazine reduced the frequency and severity of angina and improved exercise duration in patients with stable angina receiving other antianginal therapy, specifically those taking a standard dose of either atenolol, amlopidine, or diltiazem. This well-designed, well-conducted clinical trial in which patients were randomized to receive either 1 of 2 doses of ranolazine or placebo showed that both doses of ranolazine were more effective than placebo at reducing symptoms and improving exercise capacity when added to conventional doses of atenolol, diltiazem, or amlopidine.

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