Another piece of good news for a very good drug

Implications: By restoring function in the late Na channel and hence improving diastolic function (amongst other things), Ranexa has worked terrifically in my patients with any evidence for diastolic dysfunction. This typically manifests with shortness of breath and can be associated with an elevated level of BNP. This has not been as successful in patients without myocardial ischemia, but in those with ischemia the shortness of breath and associated chest discomfort has been helped in many. Including the most recent patient with a severe ischemic cardiomyopathy who has responded very very well with a significant increase in his functional capacity. Hopefully this news along with the safety from MERLIN and the A1C data and reduction in arrhythmias in that study will awaken docs to the benefits of Ranexa.  

Analysis: I think that doctors have avoided using this med due to concerns over safety and being unable to "find a place for it". I beelieve that when they focus on the wide range of symptoms that patients with CAD have (other than chest pain) they will run into shortness of breath and realize the impact on quality of life that this has. The BNP is a marker of CHF that can accompany the diastolic dysfunction seen in so many patients (predominantly older) with ischemic heart disease.