The role of trimetazidine in therapy of patients with ischemic heart disease and heart insufficiency – review of clinical trials Review article

Abstract

Conventional anti-anginal therapy improves myocardial ischemia through hemodynamic mechanisms. This includes decreasing the cardiac oxygen demands by reducing the heart rate and blood pressure values or increasing the cardiac oxygen supply by vasodilation. An alternative approach is to increase the cardiac work at a given level of oxygen consumed. Cardiac metabolic agents, a novel group of drugs, directly modify the use of energy substrates in the heart by inhibiting the free fatty acids oxidation and stimulating glucose oxidation. Epidemiologic studies have shown that patients with diabetes mellitus are far more likely to develop the coronary artery disease than non-diabetic patients. They are at higher risk of cardiac insufficiency as well. Although glycemic control remains the cornerstone of therapeutic approaches, newer treatment targets with the use of ‘metabolic agents’ are currently being explored. Trimetazidine protects the heart from the deleterious effects of ischemia, improves the left ventricular ejection fraction and exercise responses. Moreover, it has been shown to improve the endothelial function. Combined treatment with hemodynamic agents and trimetazidine is well-tolerated and effective in controlling the symptoms and signs of ischemia.