Georges Jabbour
Background: Many chronic conditions, as diabetes (DM) and cardiovascular Diseases suffer Major Adverse Cardiac Events (MACE): i myocarditis, congestive heart failure (CHF), Ventricular Tachycardia (VT), Ventricular Fibrillation (VF), Acute Coronary Syndromes [ACSs], and Sudden Cardiac Death (SCD) Acute infections, like COVID-19 also involve oxidative stress, leading to increased Sympathetic tone (S) and decreased Parasympathetic tone (P), increasing Sympathovagal Balance (SB) and MACE. The antioxidant (r)alpha lipoic acid (ALA) improves SB. The antianginal Ranolazine (RAN), also an antioxidant is an anti-arrhythmic. Our studies of their effects on MACE in DM, and non-DM patients with CHF, ventricular arrhythmias and SCD are reviewed herein, as our findings may apply to acute diseases, such as COVID-19.
Methods: In a case-control study, 109 CHF patients, 54 were given adjunctive off-label RAN added to ACC/AHA Guideline therapy (RANCHF). MACE and SB were compared with 55 NORANCHF patients; mean f/u 23.7 mo. 59 adults with triggered premature ventricular contractions (PVCs), bigeminy, and VT were given off-label RAN. Pre and post-RAN Holters were compared; mean f/u 3.1mo. 133 DM II with cardiac diabetic autonomic neuropathy were offered (r)ALA; 83 accepted; 50 refused. P&S were followed a mean of 6.31yrs, and SCDs recorded.
Results: (1) 70% of RANCHF patients increased LVEF 11.3 EFUs (p≤0.003), SCD reduced 56%; VT/VF therapies decreased 53%. (2) 95% of patients responded: VT decreased 91% (p<0.001). (3) SCD was reduced 43% in DM II patients taking (r)ALA (p=0.0076). Conclusions: RAN, (r) ALA treat CHF, VT, and prevent SCD. Trials in COVID-19 are needed.
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