Ranolazine: a better understanding of its pathophysiology and patient profile to guide treatment of chronic stable angina.

Chronic stable angina pectoris, the most prevalent symptomatic manifestation of coronary artery disease, greatly impairs quality of life and is associated with an increased risk for adverse cardiovascular outcomes. Better understanding of the pathophysiologic mechanisms of myocardial ischemia permitted new therapeutic strategies to optimize the management of angina patients. Ideally, antianginal drug treatment should be tailored to individual patient's profile and chosen according to the pathophysiology, hemodynamic profile, adverse effects, potential drug interactions and comorbidities. In this respect, and because of its peculiar mechanism of action, ranolazine represents an alternative therapeutic approach in patients with chronic stable angina and may be considered the first choice in presence of comorbidities that difficult the use of traditional therapies. Advances in the diagnosis and treatment of diseases of the coronary arteries (the vessels that provide oxygen and nutrients to the heart) have greatly reduced the mortality of heart attacks and prolonged life expectancy for many years. The consequence is a growing population with chronic disease of the coronary arteries. Healthy lifestyle (regular exercise, no smoking and healthy diet), control of risk factors (in particular, high blood pressure and high cholesterol) and the use of medications to prevent future heart attacks is of paramount importance and requires the active participation of patients and their families. Angina (chest pain or discomfort caused by reduced blood flow to the heart) is the most frequent complaint of this chronic condition and requires the use of medications (antianginal drugs) that should be selected according to the patient’s profile and the simultaneous presence of other diseases or medical conditions in the patient. This is call tailored therapy. Physicians should identify the best antianginal drug for each patient, and the patient should carefully follow instructions to improve quality of life, reduce medical visits and hospitalizations and improve outcomes.