Diabetes Patients with Chest Pain

Ranolazine helps diabetes patients with poor glucose control relieve chest pain

(RxWiki News) Diabetes patients have a high risk for coronary artery disease and as a result, they may have chest pain. A commonly used anti-anginal drug, however, can provide relief.

Angina is chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen-rich blood, according to the National Heart, Lung and Blood Institute.

Approved by the U.S. Food and Drug Administration for the treatment of chronic angina, ranolazine (brand name Ranexa) lowers frequency of chest pain in patients with type 2 diabetes—especially for those with poor blood sugar control.

"Diabetes patients: exercise and eat healthy to reduce heart problems."

Mikhail Kosiborod, MD, associate professor of medicine at the University of Missouri, Kansas City and a cardiologist at St. Luke’s Mid America Heart Institute, led this study of 927 patients with type 2 diabetes, established coronary artery disease and stable angina with at least one angina episode per week.

Participants were given either a dose of ranolazine twice daily or matching placebo for eight weeks.

Those in the ranolazine group had a lower frequency of chest pain—3.8 episodes per week on average compared to 4.3 episodes per week with placebo.

Patients in the ranolazine group also used sublingual nitroglycerin less frequently—1.7 vs. 2.1 doses per week. Nitroglycerin, taken under the tongue, relaxes and opens blood vessels so blood can flow more easily to the heart.

“Angina is associated with worse quality of life, increased risk of hospitalization and higher health care costs and appears to be more prevalent in patients with diabetes,” said Dr. Kosiborod.

“While ranolazine was shown to be effective in reducing angina in prior studies, this is the first time it has been prospectively evaluated in patients with diabetes—a high-risk and therapeutically challenging group.”

Investigators also found ranolazine was especially effective in patients with worse glucose (blood sugar) control, as measured by hemoglobin a1c (Hba1c) levels. Hba1c levels provide a snapshot of a person’s blood glucose levels over the previous two to three months.

The therapeutic superiority of ranolazine vs. placebo on reducing weekly angina frequency was more pronounced in patients with higher baseline Hba1c. Prior data shows the drug may lower fasting glucose levels in people with diabetes, thus lowering Hba1c.

“If the glucose-lowering action of ranolazine is confirmed in future studies, patients with diabetes and angina may derive a dual benefit from this drug,” said Dr. Kosiborod.

Heart diseases and stroke are the number-1 causes of death and disability among people with type 2 diabetes, according to the American Heart Association (AHA). In fact, at least 65 percent of people with diabetes die from some form of heart disease or stroke.

The AHA reports adults with diabetes are two to four times more likely to have heart disease or a stroke than adults without diabetes. The organization, however, considers diabetes to be one of the controllable risk factors for cardiovascular disease, along with smoking, lack of physical activity, obesity, and bad (LDL) cholesterol.

The study was presented in March at the American College of Cardiology’s 62nd Annual Scientific Session in San Francisco. The study was funded by Gilead Sciences, Inc.  

Reviewed by: 
Review Date: 
March 15, 2013