ESC guidelines, chronic coronary syndrome, ranolazine, diabetes mellitus, insulin resistance

The article discusses the main provisions of the updated European Society of Cardiology (ЕSC) guidelines (2024) for the treatment of chronic coronary syndrome, which provide for step-by-step management of patients with a thorough analysis of clinical symptoms, pre-test assessment of the likelihood of obstructive coronary heart disease, non-invasive and invasive studies to confirm the diagnosis. The first step in the pharmacotherapy of chronic coronary syndrome is the use of antianginal drugs (beta-blockers and/or calcium channel blockers); if the latter are not effective enough, an additional antianginal agent, ranolazine from the second-line treatment, may be prescribed. The review presents the literature data revealing ranolazine’s anti-ischemic and pleiotropic properties. The expediency of prescribing ranolazine in patients with insulin resistance and comorbid type 2 diabetes mellitus due to the ability of the drug to improve carbohydrate metabolism, reduce glycated hemoglobin without developing hypoglycaemic episodes, prevent the occurrence of new cases of diabetes mellitus.

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