Coronary artery disease is the major cause of mortality and morbidity in the industrialized countries; in the
United States of America and in Europe, it is responsible for one of every six deaths per year. In the setting of ischemic
heart disease, angina pectoris and chest pain, in particular, are the major causes of emergency department accesses. Angina
pectoris is a clinical syndrome characterized by discomfort typically in the chest, neck, chin and left arm induced by
physical exertion, emotional stress and cold and is relieved by rest or by taking of nitrates. The main targets of treatment
of angina pectoris are to improve quality of life by reducing the frequency and the severity of symptoms, to increase functional
capacity and to improve prognosis. Ranolazine is a recent antianginal drug with unique methods of action. It was
approved by the US Food and Drug Administration in 2006 as add-on therapy in patients symptomatic for stable angina.
With the inhibition of the late sodium current, Ranolazine protects against ion deregulation, prevents cellular calcium
overload and the subsequent increase in diastolic tension without impacting heart rate and blood pressure. Short term
clinical trials and patent research show that add on therapy with Ranolazine in patients with chronic stable angina significantly
improves exercise duration, exercise time to angina and reduces the use of nitro glycerine. Long term clinical trials
showed no significant differences in the rate of cardiovascular death and myocardial infarction in patients with non-ST
segment elevation acute coronary syndromes but a reduction in terms of recurrent ischemia. Ranolazine is generally well
tolerated and even if it increases the duration of QTc interval it is not associated with atrial and ventricular arrhythmias.
Therefore Ranolazine represents a good therapeutic approach in patients with chronic stable angina still symptomatic,
while on optimal anti-ischemic therapy, or intolerant to traditional anti-ischemic drugs.
Coronary Care Unit and Catheterization Laboratory, “Maggiore della Carita” Hospital, Corso Mazzini 18, 28100 Novara, Italy.