Impact of Ranolazine in Blood Markers in Women With Angina and Metabolic Syndrome

Study Overview
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Brief Summary
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The purpose of this study is to determine the effects of ranolazine on different markers of cardiometabolic disease in women with stable angina.

Detailed Description
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Evaluate the ability of ranolazine to favorably modify thrombogenic, inflammatory, lipogenic, oxidative stress and hormonal biomarkers in a relatively short period of time in a group of ethnically diverse women with chronic stable angina and metabolic syndrome.

Official Title
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Impact of Ranolazine on Inflammatory, Thrombogenic, Lipogenic, Biomarkers in Women With Angina and Metabolic Syndrome.

Conditions
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Stable Angina, Metabolic Syndrome

Intervention / Treatment
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* Drug: Ranolazine
* Other: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with chronic stable angina (> 3 months) on evidence based adequate therapy Evidence of stable coronary artery disease by any of these: MI, PCI or CABG > 30 days prior to enrollment or Angiography showing > 50% stenosis in major vessel, branch or bypass graft > 30 days of enrollment or Abnormal stress MPI nuclear study, or DBA stress echo where the decision has been to treat medically and where angina has remained stable for >= 3 months Evidence of the Metabolic Syndrome: As defined by ATP III criteria i.e 3/5 of following Abdominal circumference F > 88 cm (35 in), M > 102 cm (40 in) Hypertriglyceridemia ≥ 150 mg/dl HDL F < 50 mg/dl M < 40 mg/dl Blood Pressure ≥130/85 Fasting Glucose ≥100 mg/dl For reproductive age women, a negative urine pregnancy test is required if all other inclusion criteria are met. Exclusion Criteria: Exclusion of patients with contraindications to use of RANEXA, including patients on CYP3A4 inducers/potent inhibitors, and patients with liver cirrhosis. Exclusion of Patients with CrCl < 30 mL/min Limit dose of RANEXA to 500mg BID in patients on concurrent diltiazem/ verapamil Limit concurrent simvastatin to 20 mg/day Limit concurrent metformin to 1700 mg/day Additional Exclusion Patients with variable -inconsistent symptoms Patients with unstable coronary artery disease or revascularization within 30 days of enrollment. Patients who have known severe liver disease. Patients already receiving maximal ranolazine therapy for more than 4 weeks Presence of diabetes (AIC≥ 6.5 and /or on insulin therapy or anti-diabetic medication other than metformin) unstable hypothyroidism, active infection, active cancer (or ongoing chemotherapy and/or radiation within a year who are not on remission) and/or recent major surgery or illness. Patients with any contraindication to ranolazine see above Women of reproductive age are excluded if they are planning to become pregnant in the next 6 -12 months after randomization. Patients who are pregnant or lactating Documented allergic reaction to ranolazine in the past. Unexplained prolongation of the QTc > 500 milliseconds. Current or planned co-administration of moderate CYP3A inhibitors (eg, diltiazem, verapamil, aprepitant, erythromycin, fluconazole, and grapefruit juice or grapefruit-containing products) is not a full contraindication, if meet inclusion criteria otherwise, these patients could be accepted in trial but dose will be limited to 500 mg BID as stated previously. Current or planned co-administration of strong CYP3A inhibitors (eg, ketoconazole, itraconazole, clarithromycin, nefazodone, nelfinavir, ritonavir, indinavir, and saquinavir) OR strong CYP3A inducers (eg, rifampin, rifabutin, rifapentine, phenobarbital, phenytoin,carbamazepine, and St. John's Wort) is a contraindication.

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Ranolazine<br>Ranolazine would start with 500 mg BID and be force titrated to 1 gram po BID after 3 weeks. Down titration would only be allowed for side effects. This would be on top of all standard medical therapy. | Drug: Ranolazine<br>* Ranolazine 500 mg from baseline to week 3 and 1000 mg thereafter until week 24<br>* Other names: Ranexa;|
| Placebo Comparator: Placebo<br>Placebo arm would start with 500 mg matching placebo tablet BID and be force titrated to 1 gram matching placebo tablet twice a day after 3 weeks. Down titration would only be allowed for side effects (if reported). This would be on top of all standard medical therapy. | Other: Placebo<br>* Matching placebo tablets daily for 24 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Impact of Ranolazine on Hemoglobin A1C | Will evaluate the impact of ranolazine in HgbA1C in women with Metabolic Syndrome (MBS) | Change from baseline to 24 weeks | 
| Impact of Ranolazine on HDL-C Levels in Subjects | Will evaluate the impact of ranolazine in HDL-C levels in women with metabolic syndrome | Change from Baseline to 24 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Stable Angina, Metabolic Syndrome, Women, Biomarkers