about the role of agricultural subsidies on health ,” the authors write . “ Public health and nutrition professionals have noted a link between agricultural policy and obesity and cardiometabolic risk and have called for elimination of agricultural subsidies or at least a shift to include healthier crops .”

They conclude that : “ The cost of treating obesity-related cardiometabolic diseases in the United States is estimated to range from $ 150 billion per year to as much as $ 300 billion per year if indirect costs are included , an amount that exceeds government spending on either farm support or

nutrition assistance programs . Although eating fewer subsidized foods will not eradicate obesity , our results suggest that individuals whose diets consist of a lower proportion of subsidized foods have a lower probability of being obese . Nutritional guidelines are focused on the population ’ s needs

for healthier foods , but to date food and agricultural policies that influence food production and availability have not yet done the same .”

Siegel KR , McKeever Bullard K , Imperatore G , et al . JAMA Intern Med . 2016 ; doi : 10.1001 / jamainternmed . 2016.2410

Chronic angina may be holding him back

For patients limiting their activity due to chronic angina , adding Ranexa ® may help

In the Phase 3 CARISA trial 1

Ranexa 1000 mg BID ,* when added to a beta-blocker or calcium channel blocker , † was superior to those treatments plus placebo at :

Increasing exercise duration ( 24 secs change vs placebo from baseline at Week 12 )

Increasing the time to onset of ischemia during exercise testing at peak plasma concentrations ( 94 vs 59 secs )

Decreasing angina frequency ( 2.1 vs 3.3 avg / wk ) Decreasing nitroglycerin use ( 1.8 vs 3.1 avg doses / wk )

Learn how Ranexa may help your patients get back on track

www . RanexaHCP . com / CSWN

BID = twice daily * Limit the dose of Ranexa to 500 mg BID when coadministered with diltiazem , verapamil , or other moderate CYP3A inhibitors .

†

CARISA TRIAL DESIGN : CARISA ( Combination Assessment of Ranolazine In Stable Angina ) was a doubleblind , randomized , placebo-controlled clinical trial of 823 patients with chronic angina who received Ranexa 750 mg BID ( n = 272 ), Ranexa 1000 mg BID ( n = 261 ), or placebo ( n = 258 ) for 12 weeks ( note , 750 mg is not an approved dose ). At the physician ’ s discretion , patients received either atenolol 50 mg , amlodipine 5 mg , or diltiazem 180 mg once daily as required background antianginal therapy . Sublingual nitrates were used as needed . Corresponding P-values < 0.05 . 1

Please see following page for brief summary of full Prescribing Information .

daily , based on clinical symptoms . Ranexa should be swallowed whole ; do not crush , break or chew .

Limit the dose of Ranexa to 500 mg twice daily in patients on moderate CYP3A inhibitors ( e . g ., diltiazem , verapamil , erythromycin , fl uconazole , and grapefruit juice or grapefruit-containing products ). See Drug Interactions for additional dosing considerations .

Drug Interactions Inducers and strong inhibitors of CYP3A : Do not use Ranexa ( see Contraindications ).

Moderate CYP3A inhibitors : Limit Ranexa to 500 mg twice daily ( see Dosage and Administration ).

P-gp inhibitors ( e . g ., cyclosporine ): Ranexa exposure increased ; titrate Ranexa based on clinical response .

CYP3A substrates : Limit simvastatin to 20 mg once daily when used with Ranexa . Doses of other sensitive CYP3A substrates ( e . g ., lovastatin ) and CYP3A substrates with narrow therapeutic range ( e . g ., cyclosporine , tacrolimus , sirolimus ) may need to be reduced with Ranexa .

Drugs transported by P-gp ( e . g ., digoxin ) or metabolized by CYP2D6 ( e . g ., tricyclic antidepressants and antipsychotics ): Doses of these drugs may need to be reduced .

Drugs transported by OCT2 : Limit metformin to 1700 mg per day when used with Ranexa 1000 mg twice daily . Monitor blood glucose and risks associated with high metformin exposure .

Reference : 1 . Chaitman BR , Pepine CJ , Parker JO , et al . Effects of ranolazine with atenolol , amlodipine , or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina : a randomized controlled trial . JAMA . 2004 ; 291:309-316 .

CardioSource WorldNews | Page 25

Chronic angina may be holding him back