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April 28, 2004

Ranolazine as Add-on Therapy for Patients With Severe Chronic Angina

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(16):1959. doi:10.1001/jama.291.16.1959-a

To the Editor: Dr Chaitman and colleagues1 concluded that "ranolazine affords additional antianginal and anti-ischemic efficacy in patients with severe chronic angina who remain symptomatic while taking standard doses of atenolol, amlodipine, or diltiazem." Due to a small benefit seen in this study, as well as a significant placebo effect, we are concerned that confounding variables may have influenced these results. One such potential confounding variable not reported is the number of patients receiving statins at baseline and any changes in use throughout the study. Because the majority of patients in the trial had coronary artery disease, we assume that most would have been receiving statin therapy. In addition to their lipid-lowering ability, statins have antioxidant and anti-inflammatory properties, as well as improvements in endothelial dysfunction,2 and thus may produce similar effects as ranolazine. Statin drugs may improve symptoms of angina and improve coronary blood flow.3,4

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