Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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
Hooper JS, Busti AJ. Ranolazine as Add-on Therapy for Patients With Severe Chronic Angina. JAMA. 2004;291(16):1959. doi:10.1001/jama.291.16.1959-a