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
Chaitman et al stated that the type of concurrent antianginal therapy did not significantly modify the response to ranolazine. Figure 3 in their article, however, suggests that there may be a significant difference in patients receiving atenolol with ranolazine 1000 mg twice daily, and this effect is unexpectedly less at the lower dose of ranolazine.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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