Abstract
Introduction: Patients with diabetes mellitus (DM) have higher risk of coronary artery disease
(CAD) and angina than the general population.
Objectives: We sought to assess the impact of ranolazine as an antianginal agent to diminish
hemoglobin A1c (Hb A1c) level in diabetic individuals under treatment with metformin and
gliclazide.
Patients and Methods: This study was a randomized parallel-group clinical trial to compare
the therapeutic effects of ranolazine versus conventional treatment in patients with concomitant
T2DM and stable angina. TERISA (type 2 diabetes mellitus evaluation of ranolazine in subjects
with chronic stable angina) was employed to assess the efficiency of ranolazine in lowering the
frequency of angina attacks. The study was performed on diabetic patients with symptomatic angina
under treatment with either sublingual nitroglycerin or up to two types of antianginal agents. The
patients in the intervention group received 1000 mg ranolazine twice a day while patients in the
control group were administrated with conventional treatment. Reduction in baseline Hb A1c level
was determined at 4 and 8 weeks after the interventions.
Results: Ranolazine therapy resulted in up to 15% absolute reduction in Hb A1c level in diabetic
patients who had baseline HbA1c level >7%. Ranolazine was more efficient in reducing Hb A1c in
patients with poorly controlled disease (i.e. HbA1c>8%, P=0.017). Ranolazine did not affect the
glycemic status of patients concomitantly treated with antidiabetic therapy (P=0.560).
Conclusion: Concurrent administration of ranolazine along with anti-diabetic treatments (i.e.
metformin and gliclazide) was safe to reduce the level of HbA1c in patients with poorly controlled
diabetes and stable angina.