Author + information
- Harsh Golwala, MD∗ ()
- ↵∗University of Oklahoma Health Sciences Center, Williams Pavilion, 1130, P. O. Box 26901, Oklahoma City, Oklahoma 73190
I read with great interest the paper by Kosiborod et al. (1) showing beneficial effects of ranolazine in patients with type 2 diabetes mellitus, coronary artery disease, and chronic refractory angina taking 2 antianginal agents. The authors demonstrate superior efficacy of ranolazine in reducing weekly anginal episodes, as well as weekly nitroglycerin use in this patient population.
The study design raises few important questions: First, >50% of the patients in the study were not taking two antianginal medications. Given the systolic blood pressure of >130 mm Hg in both of the groups at the beginning of the study and the fact that approximately only 34% of patients in each group were taking nitrate therapy prior to enrollment, it would be beneficial to know the doses of long-acting nitrates in these patients as there was adequate room to up-titrate the nitrate therapy and the patients were not truly refractory to 2 antianginal medications. Second, it would be important for the readers to know whether the beneficial effect of ranolazine was extended for the duration of angina as well as the ischemic burden in this patient group (as assessed objectively by means of Holter electrocardiogram or other cardiac monitoring devices).
Third, a previous subgroup analysis from a trial of ranolazine (2) showed that the effect of reduction in A1c was greater in diabetic patients taking insulin than in those not taking insulin therapy. Again, it would be interesting to see if those results are replicable in the TERISA trial study population.
- American College of Cardiology Foundation
- Kosiborod M.,
- Arnold S.V.,
- Spertus J.A.,
- et al.
- Timmis A.D.,
- Chaitman B.R.,
- Crager M.