Pharmacological treatment of stable angina pectoris: the place of trimetazidine

Abstract

According to international epidemiological studies, the total number of reported cases of cardiovascular diseases (CVD) almost doubled from 1990 to 2019, reaching 523 million and the number of deaths from CVD in 2019 increased by more than 1.5 times (18,6 million). Coronary artery disease (CAD) and stroke are the main contributors to these unfavorable trends. The number of registered cases of coronary heart disease in 2019 amounted to 197 million, and the number of deaths caused by coronary artery disease exceeded half of all registered cases of cardiovascular death (9,14 million). Patients with stable angina are the majority of patients with CAD. Despite the existing modern methods of treating angina pectoris, patients with chronic coronary artery disease continue to suffer from anginal pain, which significantly reduces exercise tolerance and worsens their quality of life. In clinical practice, the severity and frequency of angina pectoris in patients remain underestimated by doctors, and drug therapy is not corrected in a timely manner, and the possibilities of combined antianginal therapy are not used. Trimetazidine, as an antianginal drug that acts on the metabolism of ischemic myocardial cells (influence on the ischemic cascade, by reducing cellular acidosis and increasing ATP content), is effective and safety for the treatment of angina pectoris, regardless of the mechanism that caused ischemia as monotherapy and in the combination, primarily with beta-blockers.