Ranolazine improves insulin resistance in non-diabetic patients with coronary heart disease. A pilot study.

Background The aim of this pilot study was to evaluate if ranolazine (R) could improve insulin resistance (IR) in obese/overweight non-diabetic patients with coronary heart disease (CHD). Methods The study enrolled 40 patients with already diagnosed CHD, previous revascularization, residual ischemia at ergometric test and IR. Mean age was 62.4 ± 9 years, M/F = 31/9. Patients were randomly assigned to one of the two following groups: group 1 (20 patients) started R at dose of 500 mg/bid; group 2 (20 patients) increased the dose of beta/blockers or calcium-channel blockers without introducing R. IR was defined as having HOMA-IR > 2.5. At baseline and after 12 weeks, all subjects performed an ergometric test and 12 h fasting blood sample collection for determining glucose and insulin levels. Results At 12 weeks follow-up visit HOMA-IR significantly decreased in group 1 (from 3.1 ± 1.7 to 2.3 ± 0.9; p = 0.02) while it remained unchanged in group 2 (from 3.0 ± 1.4 to 2.8 ± 1.2; p = 0.14) (between groups p = 0.009). At 12 weeks follow-up visit patients of both groups obtained a significant increase of ischemic threshold at ergometric test, compared to baseline, (group 1 from 308.4 ± 45 s to 423.9 ± 57 s, p = 0.0004); (group 1 from 315.7 ± 63 s to 441.2 ± 51 s, p = 0.0001); without between groups difference (p = 0.25). Conclusions Our data suggest that starting R, instead of increasing the dose of beta-blockers/calcium-channel blockers, could be a preferable choice in obese/overweight CHD subjects with residual ischemia after revascularization.