Trimetazidine in Cardiovascular Disease and Beyond: A Comprehensive Review

Area of Science:

• Cardiology
• Metabolic Medicine
• Pharmacology

Background:

• Trimetazidine is a metabolic modulator targeting the beta-oxidation pathway.
• It shifts cellular energy substrate from fatty acids to glucose, improving oxygen efficiency.
• This mechanism underlies its anti-ischemic and anti-anginal effects.

Purpose of the Study:

• To review the mechanism of action of trimetazidine.
• To summarize its efficacy in treating angina.
• To discuss its broader applications in cardiovascular diseases based on pleiotropic effects.

Main Methods:

• Literature review of trimetazidine's mechanism of action.
• Analysis of clinical data on anti-anginal efficacy.
• Exploration of evidence for antioxidant, cytoprotective, and anti-apoptotic activities.

Main Results:

• Trimetazidine competitively inhibits beta-oxidation, promoting glucose metabolism.
• This shift conserves cellular ATP during ischemia/hypoxia, mediating anti-ischemic effects.
• Clinical use is approved as add-on therapy for symptomatic angina.

Conclusions:

• Trimetazidine's metabolic modulation provides anti-anginal benefits.
• Its pleiotropic effects, including antioxidant and cytoprotective actions, suggest wider cardiovascular applications.
• Further research supports its role beyond angina treatment in cardiovascular medicine.