Vascular Health and Risk Management Open Access Full Text Article Dovepress open access to scientific and medical research R e V i e w extended-release ranolazine: critical evaluation of its use in stable angina Adriano AM Truffa L Kristin Newby Chiara Melloni Duke Clinical Research institute and Department of Medicine, Duke University Medical Center, Durham, NC, USA Correspondence: Chiara Melloni 2400 Pratt St, Durham, NC, USA 27705 Tel +1 919 668 8646 Fax +1 919 668 7057 email mello004@mc.duke.edu submit your manuscript | www.dovepress.com Dovepress http://dx.doi.org/10.2147/VHRM.S15560 Abstract: Coronary heart disease is the major cause of morbidity and mortality throughout the world, and is responsible for approximately one of every six deaths in the US. Angina pectoris is a clinical syndrome characterized by discomfort, typically in the chest, neck, chin, or left arm, induced by physical exertion, emotional stress, or cold, and relieved by rest or nitroglycerin. The main goals of treatment of stable angina pectoris are to improve quality of life by reducing the severity and/or frequency of symptoms, to increase functional capacity, and to improve prognosis. Ranolazine is a recently developed antianginal with unique methods of action. In this paper, we review the pharmacology of ranolazine, clinical trials supporting its approval for clinical use, and studies of its quality of life benefits. We conclude that ranolazine has been shown to be a reasonable and safe option for patients who have refractory ischemic symptoms despite the use of standard medications (for example, nitrates, beta-adrenergic receptor antago- nists, and calcium channel antagonists) for treatment of anginal symptoms, and also provides a modestly improved quality of life. Keywords: ranolazine, coronary heart disease, angina, treatment Introduction Coronary heart disease is the major cause of morbidity and mortality throughout the world.1 About 16.3 million people in the US have coronary heart disease and an estimated 8.9 million people have chronic stable angina.2,3 Coronary heart disease is responsible for approximately one of every six deaths in the US,3 and based on data from 2007, the estimated direct and indirect cost of coronary heart disease in the US annually exceeds $177.5 billion.3,4 Angina pectoris is a clinical syndrome characterized by discomfort, typically in the chest, neck, chin, or left arm, induced by physical exertion, emotional stress, or cold, and is relieved by rest or nitroglycerin.2 It is present symptomatically in only 18% of coronary artery disease.3 Chronic stable angina is usually caused by partial but flow-limiting obstruction of at least one of the major coronary arteries or its branches by atheromatous plaque, resulting in myocardial ischemia as a result of a mismatch between myocardial oxygen demand and supply.5 The general management of chronic stable angina is directed at medical therapy to reduce coronary heart disease progression, as well as therapies and lifestyle modifica- tion to control or eliminate coronary heart disease risk factors (smoking, high blood pressure, diabetes mellitus, hyperlipidemia, physical inactivity, weight management, and influenza vaccination).2,6 Vascular Health and Risk Management 2011:7 535–539 © 2011 Truffa et al, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 535