Defining the Role of Trimetazidine in the Treatment of Cardiovascular Disorders: Some Insights on Its Role in Heart Failure and Peripheral Artery Disease

Abstract

Trimetazidine is a cytoprotective drug whose cardiovascular effectiveness, especially in patients with stable ischemic heart disease, has been the source of much controversy in recent years; some have gone so far as to treat the medication as a ‘placebo drug’ whose new side effects, such as Parkinsonian symptoms, outweigh its benefits. This article is an attempt to present the recent key studies, including meta-analyses, on the use of trimetazidine in chronic heart failure, also in patients with diabetes mellitus and arrhythmia, as well as in peripheral artery disease. This paper also includes the most recent European Society of Cardiology guidelines, including those of 2013, on the use of trimetazidine in cardiovascular disease.

Nicotinamide mononucleotide requires SIRT3 to improve cardiac function and bioenergetics in a Friedreich’s ataxia cardiomyopathy model

“…For example, the partial FA oxidation inhibitor trimetazidine directly acts on FA oxidation but indirectly improves carbohydrate metabolism in HF patients (49). Similar to the effects of NMN in the FXN-KO heart, trimetazidine improves LV systolic function, elevates the cardiac PCr/ATP ratio, and decreases cellular acidosis in human patients with congestive or ischemic failing hearts (37,(50)(51)(52)(53). These effects are achieved by a global reduction in resting EE with a concomitant whole-body and cardiac decrease in FA oxidation and increase in glucose oxidation (37,50,53).…”

The Effectiveness of Preoperative Trimetazidine on Myocardial Preservation in Coronary Artery Bypass Graft Patients: A Systematic Review and Meta-Analysis

“…First, it inhibits long-chain mitochondrial 3-ketoacyl coenzyme A thiolase, which plays a key role in β-oxidation in cardiomyocytes [25]. This action switches cardiomyocyte metabolism from free fatty acid oxidation to glucose oxidation, which is more efficient at oxygen consumption and ATP production [25].…”

Antiischemic Metabolic Modulator Trimetazidine in Treatment of Coronary Heart Disease

“…В ряде работ показано, что у больных ИБС, прини-мавших ТМЗ, улучшалась миокардиальная перфузия и повышалась сократимость миокарда [24,25]. Подобная эффективность ТМЗ была продемонстри-рована у мужчин и женщин, что позволяет рекомен-довать этот метаболический агент для пациентов с ишемической болезнью сердца, независимо от пола, а также у пациентов с сопутствующим сахарным диа-бетом и периферическим атеросклерозом [26][27][28][29][30][31].…”