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Cardiovascular Drugs and Therapy

, Volume 27, Issue 1, pp 69–77 | Cite as

Anti-Anginal and Anti-Ischemic Effects of Late Sodium Current Inhibition

  • Neil J. Wimmer
  • Peter H. Stone
REVIEW ARTICLE

Abstract

The effective treatment of coronary artery disease targets two distinct goals, controlling symptomatic angina and decreasing the adverse events associated with ischemia. Traditional anti-anginal and anti-ischemic drugs function by altering the determinants of myocardial oxygen supply or demand, usually by altering loading conditions, changing the heart rate, or impacting contractility. Blockade of the late inward sodium current, late INa, offers another target for the treatment of ischemia. Blockade of late INa reduces the sodium and calcium overload that follows ischemia. This improves myocardial relaxation and reduces left ventricular diastolic stiffness, in turn enhancing myocardial contractility and perfusion. Ranolazine, a late INa inhibitor, has been shown to provide both anti-anginal and anti-ischemic benefits without significant alterations in the heart rate and blood pressure in patients with stable coronary artery disease. When evaluated in patients with acute coronary syndrome, ranolazine has been shown to decrease recurrent ischemia, but not significantly reduce the risk of death or myocardial infarction. This review will address the rationale that inhibition of the late sodium current is beneficial in reducing cardiac dysfunction during ischemia, and discuss the clinical studies supporting the use of ranolazine for its anti-anginal and anti-ischemic effects.

Keywords

Ischemia Angina Sodium current Ranolazine 

Notes

Disclosures

Dr. Wimmer has no disclosures. Dr. Stone has no disclosures.

Funding

Dr. Wimmer receives research support from NIH T32HL007604.

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Division of Cardiovascular MedicineBrigham and Women’s HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA

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