JACC：雷诺嗪可降低心绞痛发作频率

　　美国学者的一项研究表明，在伴有糖尿病的慢性心绞痛患者中，雷诺嗪可降低心绞痛发作频率及舌下硝酸甘油用量，且耐受性良好。论文于2013年3月10日在线发表于《美国心脏病学会杂志》（J Am Coll Cardiol）。

　　此项国际性、随机、双盲试验以伴糖尿病、冠脉疾病及稳定性心绞痛并且接受1～2种抗心绞痛药物治疗的患者为受试者。在为期4周的单盲安慰剂导入期后，患者被随机给予为期8周的雷诺嗪（目标剂量1000mg bid）或安慰剂治疗。利用电子日记记录心绞痛发作和硝酸甘油应用情况。主要转归为最后6周的每周心绞痛平均发作次数。

　　结果显示，共有来自于14个国家的949例患者被纳入研究；平均年龄64岁，男性为61%，平均糖尿病持续时间为7.5年，基线HbA1c为7.3%。两组患者的电子日记资料采集率均为98%。雷诺嗪组的每周心绞痛发作频率显著低于安慰剂组（P=0.008），每周舌下硝酸甘油应用剂量亦为如此（P=0.003）。两组患者在严重不良事件发生率方面无差异。

与心绞痛相关的拓展阅读：

• Am J Cardiol:他汀可减少不稳定心绞痛患者冠脉斑块体积
• 运动可通过循环协同适应改善心绞痛患者心脏功能
• Circulation：阿司匹林仍是治疗不稳定型心绞痛的首选药物
• [ACC2012]GIK急救心绞痛能否减缓心梗进展仍是谜
• 中国慢性稳定性心绞痛诊断与治疗指南
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Evaluation of Ranolazine in Patients with Type 2 Diabetes Mellitus and Chronic Stable Angina. Results from the TERISA randomized clinical trial ONLINE FIRST

Objectives  

To examine the efficacy of ranolazine versus placebo on weekly angina frequency in subjects with type 2 diabetes, CAD, and chronic stable angina who remain symptomatic despite treatment with up to 2 antianginal agents.

Background  

Patients with diabetes have more extensive coronary artery disease (CAD) than those without diabetes, and a high burden of angina. Ranolazine is not only effective in treating angina but also may improve glycemic control, thus providing several potential benefits in this high-risk group. We conducted a randomized trial to test the antianginal benefit of ranolazine in patients with diabetes and stable angina.

Methods  

TERISA was an international, randomized, double-blind trial of ranolazine vs. placebo in patients with diabetes, CAD, and stable angina treated with 1-2 antianginals. After a single-blind, 4-week placebo run-in, patients were randomized to 8 weeks of double-blind ranolazine (target dose 1000 mg bid) or placebo. Anginal episodes and nitroglycerin use were recorded with daily entry into a novel electronic diary. Primary outcome was the average weekly number of anginal episodes over the last 6 weeks of the study.

Results  

A total of 949 patients were randomized across 104 centers in 14 countries. Mean age was 64 years, 61% were men, mean diabetes duration was 7.5 yrs, and mean baseline HbA1c was 7.3%. Electronic diary data capture was 98% in both groups. Weekly angina frequency was significantly lower with ranolazine versus placebo (3.8 [3.6-4.1] vs. 4.3 [4.0-4.5] episodes, P=0.008), as was the weekly sublingual nitroglycerin use (1.7 [1.6-1.9] vs. 2.1 [1.9-2.3] doses, P=0.003). There was no difference in the incidence of serious adverse events between groups.

Conclusions  

Among patients with diabetes and chronic angina despite treatment with up to 2 agents, ranolazine reduced angina and sublingual nitroglycerin use and was well tolerated.