Trimetazidine in the treatment of angina pectoris and other forms of IHD
Authors:
V. Chaloupka
Published in:
Kardiol Rev Int Med 2005, 7(1): 17-20
Overview
Trimetazidine, piperazine derivative, is practically the only drug from the group of metabolic modulators used in the clinical practice
in the angina pectoris treatment. The principle of the effect of trimetazidine is selective inhibition of enzyme of beta oxidation of fatty acids in mitochondria, 3-ketoacyl-CoA-thiolase (3-KAT). The result is partial inhibition of fatty acids oxidation and stimulation of glucose oxidation. Trimetazidine has demonstrable antianginose effects in monotherapy and in the combined treatment. Former papers have already shown that TMZ has efficacy comparable with classic haemodynamic drugs. Trimetazidine is indicated mainly in the prophylaxis of angina pectoris. However, cytoprotective effects assert in other forms of ischaemic heart disease too and they are not necessarily bound on the occurrence of angina pectoris. Trimetazidine is excellently tolerated and therefore it is suitable in elderly patients, diabetics and polymorbid patients.
Keywords:
trimetazidine – angina pectoris – ischaemic heart disease – metabolic treatment
Sources
1. Bultas J. Léčba anginy pectoris. Jak dnes, jak zítra? Medicína po promoci 2004; 5: 14–30.
2. Packer M. Drug Therapy: Combined beta–adrenergic and calcium–entry blockade in angina pectoris. N Engl J Med 1989; 320: 709–718.
3. Savonitto S, Ardissino D, Egstrup K et al. Combination therapy with metoprolol and nifedepine versus monotherapy in patients with stable angina pectoris. International Multicenter Angina (IMAGE) Study. J Am Coll Cardiol 1996; 27: 311–316.
4. Hradec M, Chaloupka V, Sachová M. Angina treatment Patterns Survey: Současný stav diagnostiky a léčby nemocných se stabilní anginou pectoris v České republice. Cor Vasa 2003; 45: 173–180.
5. Lopaschuk GD. Pharmacologic rationale for trimetazidine in the treatment of ischemic heart disease. Am J Cardiovasc Drugs 2003; 3(Suppl I): 21–26.
6. Marzilli M. Cardioprotective effects of trimetazidine: a review. Curr Med Res Opin 2003; 19: 661–672.
7. Hradec J. Lékové profily. Trimetazidinum. 2003; 13: 8–75.
8. Kantor P, Lucien A, Kozak R, Lopaschuk G. The antianginal drug trimetazidine shifts cardiac energy metabolism from fatty acid oxidation to glucose oxidation by inhibiting mitochondrial long–chain 3–ketoacyl coenzyme A thiolase. Circ Res 2000; 86: 580–588.
9. Marzilli M, Klein WW. Efficacy and tolerability of trimetazidine in stable angina: a meta–analysis of randomized, double–blind, controlled trials. Cor Art Dis 2003; 14: 171–179.
10. Detry JM, Sellier P, Pennaforte S et al. Trimetazidine: a new concept in the treatment of angina. Comparison with propranolol in patients with stable angina. Trimetazidine European Multicenter Study (TEMS) Group. Br J Clin Pharmacol 1994; 37: 279–288.11. Manchanda SC, Krishnaswami S. Combination treatment with trimetazidine and diltiazem in stable angina pectoris. Heart 1997; 78: 353–357.
12. Levy S and Group of South of France Investigators. Combination therapy of trimetazidine with diltiazem in patients with coronary artery disease. Am J Cardiol 1995; 76(6): 12B–16B.
13. Michaelides PA, Spiropoulos K, Dimopoulos K et al. Antianginal efficacy of the combination of trimetazidine–propranolol compared with monosorbide dinitrate–propranolol in patients with stable angina. Clin Drug Invest 1997; 13: 8–14.
14. Szwed H, Sadowski Z, Elikowski W et al. Combination treatment in stable effort angina using trimetazidine and metoprolol. Results of randomized, double–blind, multicentre study (TRIMPOL II). Eur Hear J 2001; 22: 2267–2274.
15. Hradec J, Filipová J. TRIKET I a II (TRImetazidin v Kombinaci s Existující Terapií) – Výsledky české a slovenské multicentrické studie u 320 nemocných se stabilní námahovou anginou pectoris. Cor Vasa 2001; 43: 436–442.
16. Kolbel F, BadaV. Trimetazidine in geriatric patients with stable angina pectoris: The Tiger Study. Int J Clin Pract 2003; 57: 867–870.
17. Vitale C, Wajngaten M, Sposato B et al. Trimetazidine improves left ventricular function and quality of live in elderly patients with coronary artery disease. Eur Heart J 2004; 25: 1814–1821.
18. Lu C, Dabrowski P, Fragasso G et al. Effects of trimetazidine on ischemic left ventricular dysfunction in patients with coronary artery disease. Am J Cardiol 1998; 82: 898–901.
19. Fragasso G, Piatti PM, Monti L et al. Short– and long–term beneficial effects of trimetazidine in patients with diabetes and ischemic cardiomyopathy. Am Heart J 2003; 146: 18–25.
20. Sellier P, Broustet JP. Assessment of anti–ischemic and antianginal effect at trough plasma concentration and safety of trimetazidine MR 35mg in patients with stable angina pectoris. Am J Cardiovasc Drugs 2003; 3: 361–369.
21. Makolkin VI, Osadchiy K. Trimetazidine modified release in the treatment of stable angina. Clin Drug Invest 2004; 24: 731–738.
22. Belardinelli R, Purcaro A. Effects of trimetazidine on the contractile response of chronically dysfunctional myocardium to low–dose dobutamine in ischemic cardiomyopathy. Eur Heart J 2001; 23: 2164–2170.
23. Chierchia SL. Trimetazidine and left ventricular ischaemic dysfunction: an overview of clinical evidence. Eur Heart J 2001; 3(Suppl O): 16–20.
24. Fragasso G, Piatti PM, Monti L et al. Acute effects of heparin administration on the ischemic threshold of patients with coronary artery disease: evaluation of the protective role of the metabolic modulator trimetazidine. J Am Coll Cardiol 2002; 39: 413–419.
25. Tünerir B, Colak Ö, Alatas Ö et al. Measurement of troponin T to detect cardioprotective effect of trimetazidine during coronary artery bypass grafting. Ann Thorac Surg 1999; 68: 2173–2176.
26. Polonski L, Dec I, Wojnar R et al. Trimetazidine limits the effects of myocardial ischaemia during percutaneous coronary angioplasty. Curr Med Res Opin 2002; 18(7): 389–396.
27. Haffner SM, Lehto S, Ronnemaa T et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339(4): 229–234.
28. Coutinho M, Gerstein HC, Wang Y et al. The relationship between glucose and incident cardiovascular events: a metaregression analysis of published data from 20 studies of 95 783 individuals followed for 12.4 years. Diabetes Care 1999; 22(2): 233–240.
29. Bartnik M, Rydén L, Ferrari R et al. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart. Eur Heart J 2004; 25(21): 1880–1890.
30. Pyorala K, Lehto S, De Bacquer D et al (On behalf of the EUROASPIRE I and II Groups). Risk factor management in diabetic and non–diabetic patients with coronary heart disease. Findings from the EUROASPIRE I and II surveys. Diabetologia 2004; 47(7): 1257–1265.
31. Hasdai D, Behar S, Wallentin L et al. A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; The Euro Heart Survey of Acute Coronary Syndromes. Eur Heart J 2002; 23(15): 1190–1201.
32. Szwed H, Sadowski Z, Pachocki R et al. The antiischemic effects and tolerability of trimetazidine in coronary diabetic patients. A substudy from TRIMPOL–1. Cardiovasc Drugs Ther 1999; 13(3): 217–222.
33. Rosano GMC, Vitale C, Sposato B et al. Trimetazidine improves left ventricular function in diabetic patients with coronary artery disease: a double–blind placebo–controlled study. Cardiovasc Diabetol 2003; 2(1): 16–25.
Labels
Paediatric cardiology Internal medicine Cardiac surgery CardiologyArticle was published in
Cardiology Review
2005 Issue 1
Most read in this issue
- Trimetazidine in the treatment of angina pectoris and other forms of IHD
- Practical aspects and news in pharmacological treatment of arrhythmias
- Rehabilitation after myocardial infarction
- Antialdosteronics renaissance in the contemporary cardiology