Evaluation of the Impact of Ranolazine Treatment on Liver Function Tests in Patients With Coronary Heart Disease and Nonalcoholic Fatty Liver Disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common liver pathology in the developed world. Nonalcoholic fatty liver disease is associated with a higher risk of cardiovascular disease. We investigated the impact of ranolazine on liver tests in patients with NAFLD and coronary artery disease (CAD). Patients who had established CAD and NAFLD (as assessed by raised serum transaminase activity, sonographic criteria, and the absence of any other obvious liver disease) were allocated to “on ranolazine” (n = 40) or “not on ranolazine” (n = 35) groups. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured in all patients at baseline and at the end of the study. After 6 months of ranolazine treatment, both ALT and AST activities were significantly lower in patients in the “on ranolazine” group compared with “not on ranolazine” patients (change from baseline: ALT, −11.0 ± 1.7 IU/L, P < .001; AST, −5.2 ± 1.9 IU/L, P =.009). In conclusion, the present study showed that treatment with ranolazine for 6 months led to a significant reduction in the activities of both serum aminotransferases in patients with stable CAD and NAFLD.

The Impact of Ranolazine Treatment on Liver Tests in Patients With Coronary Artery Disease and Nonalcoholic Fatty Liver Disease

“…In this context, statins are a favorable option possibly combined with ranolazine. Larger, randomized, placebo-controlled trials are needed to confirm the interesting preliminary findings reported by Esenboga et al 10 These findings may influence the choice of treatment for patients with angina and NAFLD.…”

“…Lipid levels, renal function tests, g-glutamyl transpeptidase activity, and albumin levels were not affected by the use of ranolazine. 10 This is the first study assessing the impact of ranolazine in patients with overt CV disease and NAFLD, and it showed potential benefits with ranolazine on liver tests. 10 However, to establish any potential benefits of ranolazine (or any drug) on NAFLD, the use of liver biopsy to identify relevant ameliorating effects is necessary, since this is considered as the gold standard for the diagnosis of NAFLD and NASH.…”

“…10 This is the first study assessing the impact of ranolazine in patients with overt CV disease and NAFLD, and it showed potential benefits with ranolazine on liver tests. 10 However, to establish any potential benefits of ranolazine (or any drug) on NAFLD, the use of liver biopsy to identify relevant ameliorating effects is necessary, since this is considered as the gold standard for the diagnosis of NAFLD and NASH. 10,11 Furthermore, the Esenboga et al 10 study population is relatively small and the nonrandomized design of the study limits the validity of its findings.…”

“…9 In this issue of Angiology, Esenboga et al assessed the impact of ranolazine on liver enzymes in patients with CAD and ultrasound-diagnosed NAFLD. 10 Ranolazine was administrated to 40 patients with stable angina as add-on treatment to b-blocker and/or calcium channel blocker therapy, while 35 patients were treated with conventional antianginal treatment without ranolazine. After 6 months, both aspartate and alanine aminotransferase activities were significantly reduced with ranolazine use compared with patients not receiving this treatment.…”

“…10 However, to establish any potential benefits of ranolazine (or any drug) on NAFLD, the use of liver biopsy to identify relevant ameliorating effects is necessary, since this is considered as the gold standard for the diagnosis of NAFLD and NASH. 10,11 Furthermore, the Esenboga et al 10 study population is relatively small and the nonrandomized design of the study limits the validity of its findings. Surprisingly, at least one other antianginal drug (trimetazidine) has been reported to have beneficial effects on NAFLD.…”