In this issue of THE JOURNAL, Chaitman and colleagues1 report
the results of the Combination Assessment of Ranolazine In Stable Angina (CARISA)
trial, an important study evaluating ranolazine, a new antianginal drug. Ranolazine
is the first member of a new class of drugs believed to reduce angina by partially
inhibiting fatty acid oxidation, thereby increasing glucose oxidation and
generating more ATP (adenosine triphosphate) per molecule of oxygen consumed.2,3 In the Monotherapy Assessment of Ranolazine
In Stable Angina (MARISA) trial, an earlier placebo-controlled, double-blind
trial of the same drug, ranolazine reduced angina and objective evidence of
ischemia among patients who were taking no other antianginal medications.4 In CARISA, ranolazine reduced the frequency and severity
of angina and improved exercise duration in patients with stable angina receiving
other antianginal therapy, specifically those taking a standard dose of either
atenolol, amlopidine, or diltiazem. This well-designed, well-conducted clinical
trial in which patients were randomized to receive either 1 of 2 doses of
ranolazine or placebo showed that both doses of ranolazine were more effective
than placebo at reducing symptoms and improving exercise capacity when added
to conventional doses of atenolol, diltiazem, or amlopidine.
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