Ranolazine: a novel therapeutic option in chronic stable angina.

hronic stable angina (CSA) represents the largest cardiovascular disorder in the United States and is the initial clinical presentation of ischemic heart disease in 50% of patients. CSA is the result of the progression of coronary atherosclerosis and becomes symptomatic once the luminal diameter of the vessel is occluded by >50%. Current medical therapy is targeted at reducing the frequency of anginal symptoms and improving exercise tolerance by increasing myocardial oxygen supply via arteriole dilation (i.e., dihydropyridine calcium channel blockers, nitrate therapy) and/or reducing myocardial oxygen demand by reducing heart rate and contractility (i.e., non-dihydropyridine calcium channel antagonists and β-adrenergic antagonists). Combinations of these agents can induce profound reductions in blood pressure that limit the aggressive dosing needed in some CSA patients.