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Trimetazidine for stable angina pectoris
1Department of Pathology, Box 3712, Duke University Medical Center, Durham NC 27710, USA. cross017@mc.duke.edu
Insights
Trimetazidine effectively treats stable angina pectoris symptoms by improving exercise capacity and reducing chest pain. This metabolic agent offers a safe alternative or addition to traditional medications without depressing cardiac function.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Stable angina pectoris is a symptom of coronary heart disease (CHD) causing chest pain during ischaemia.
- Current treatments include beta-blockers, calcium antagonists, and nitrates, aiming to reduce cardiac workload or improve coronary blood flow.
Purpose of the Study:
- To evaluate trimetazidine, a metabolic agent, as a treatment for stable angina pectoris.
- To compare trimetazidine's efficacy and safety against placebo and existing anti-anginal medications.
Main Methods:
- Systematic review of clinical trials investigating trimetazidine (20 mg t.i.d.) in stable angina patients.
- Comparison of exercise capacity, anginal incidence, and left-ventricular function between trimetazidine and placebo/active comparators.
Main Results:
- Trimetazidine significantly improved exercise capacity and decreased anginal episodes compared to placebo.
- Efficacy was comparable to propranolol and nifedipine, and superior to isosorbide dinitrate in some cases.
- Trimetazidine demonstrated a favorable safety profile with mild, infrequent adverse effects and no cardiac depression.
Conclusions:
- Trimetazidine is a safe and effective monotherapy or adjunctive treatment for stable angina symptoms.
- Further long-term studies are needed to assess its impact on myocardial infarction (MI) and mortality rates.
Abstract:
Stable angina pectoris, a symptom of coronary heart disease (CHD), manifests as stress-induced ischaemic episodes resulting in severe chest pain. Therapeutic aims are to improve quality of life by decreasing anginal attacks and to prevent myocardial infarction (MI) and death. Current anginal medications include beta-blockers and calcium antagonists, which decrease ischaemic severity by reducing cardiac workload, and nitrates, which increase coronary blood flow. A new therapeutic approach is the use of metabolic agents, such as trimetazidine, which are cytoprotective during ischaemia. Results of several clinical trials demonstrated that trimetazidine, at the standard dose of 20 mg t.i.d., increased exercise capacity, decreased anginal incidence and decreased left-ventricular (LV) dysfunction compared to placebo. Trimetazidine was also as effective as propranolol (120 - 160 mg/day) and nifedipine (40 mg/day) in decreasing anginal episodes and improving exercise parameters. Trimetazidine improved anginal frequency and symptoms in patients in which treatment with diltiazem, nifedipine, propranolol, pindolol, oxprenolol or long-acting nitrates had failed. Trimetazidine was also more effective than isosorbide dinitrate (30 mg/day) as an adjunct to propranolol. Despite efficacy being equivalent to that of beta-blockers and calcium antagonists, trimetazidine does not depress cardiac function and, correspondingly, is not contraindicated in any condition. Adverse effects of trimetazidine are mild and infrequent. In summary, clinical data indicate that trimetazidine is a safe, effective treatment for the symptoms of stable angina pectoris when used either as a monotherapy or an adjunctive therapy. Longer-term trials are necessary to determine whether trimetazidine will be effective in reducing rates of mortality and MI.