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VOL. 11, ISSUE 1 (2026)
Clinical meta-analysis of Trimetazidine with Ranolazine in angina pectoris
Authors
Sandeep Goyal, Rakesh Chawla, Vijender Kumar, Hardik Kumar, Fayiz Ul Haq
Abstract
Angina pectoris is a
significant cause of ischemic heart disease and a cause of high morbidity and
mortality in cardiovascular diseases worldwide. Trimetazidine and ranolazine
are metabolite antianginal agents employed as an adjunct treatment in those with
chronic stable angina. But there is no consistent evidence on their clinical
effectiveness and safety as compared to other evidence. To compare and contrast
the effectiveness and safety of trimetazidine and ranolazine with placebo in
the management of angina pectoris in patients. It is a systematic review and a
meta-analysis of randomized controlled trials by the PRISMA guidelines,
published between 2000 and 2022. Search was done on databases such as PubMed,
MEDLINE, Cochrane Library, Elsevier and ScienceDirect. Patients with angina
pectoris or ischemic heart disease treated with either trimetazidine or
ranolazine and reporting exercise-based and clinical outcomes were included in
the trials. The main outcomes comprised the heart rate during peak exercise, duration
of exercise test, the time to onset of angina, the number of attacks with
angina per week, ST-segment depression 1-mm, and adverse drug reactions.
Statistical tools were used to conduct statistical analysis using SPSS version
26. It consisted of 18 randomized trials, including 7,505 patients who were
treated with trimetazidine and 6,823 who were treated with ranolazine. Both
drugs resulted in no clinically significant difference between the heart rate
at peak exercise and placebo. Ranolazine showed statistically significant and
consistent increase in the exercise test duration, time to angina onset,
st-segment depression and anginal frequency, though the heterogeneity between
studies was minimal. Trimetazidine resulted in large depression of 1-mm ST-segments
and angina attacks weekly, and lower heart rates during exercise albeit with a
high degree of heterogeneity. There was no significant difference between the
adverse drug reactions of the two agents and placebo, and the trimetazidine has
a relatively good safety profile. Both ranolazine and trimetazidine are
effective and are normally safe in the treatment of chronic stable angina
pectoris. Ranolazine was more consistent and statistically stronger between
exercises and ischemic, whereas trimetazidine was more effective in the
reduction of ST-segment depression, lowering exercise heart rates, increasing
exercise durations, and decreasing the frequency of angina weekly. On the
whole, the overall meta-analysis results prove that trimetazidine is a more
effective agent regarding the criteria measured, but more high-quality
head-to-head trials are justified to define their clinical roles in comparison
with each other.
Pages:94-98
How to cite this article:
Sandeep Goyal, Rakesh Chawla, Vijender Kumar, Hardik Kumar, Fayiz Ul Haq "Clinical meta-analysis of Trimetazidine with Ranolazine in angina pectoris". International Journal of Research in Pharmacy and
Pharmaceutical Sciences, Vol 11, Issue 1, 2026, Pages 94-98
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