Trimetazidine may improve cardiac energetics and efficiency in stable CAD

Elvira Manzano
21 Nov 2016
Prof Michel Komajda

Newer metabolic agents, including trimetazidine, represent ancillary forms of prophylactic antianginal therapy and may be useful in patients with stable coronary artery disease (SCAD) who are unsuitable for percutaneous or surgical revascularization, says a leading cardiologist at the recent AFCC 2016.

“On top of its antianginal properties, trimetazidine, administered at 35 mg twice daily, modulates myocardial metabolic efficiency and is recognized as a second-line agent in those whose angina persists despite use of standard antianginal therapy, and who are not suitable for invasive revascularization,” said Prof Michel Komajda from the University Pierre et Marie Curie and the Pitie Salpetriere Hospital in Paris, France.

Trimetazidine reduces the mismatch between oxygen demand and delivery through a shift in cardiac metabolism in ischaemic conditions. “It shifts the cardiac cell metabolism from free fatty acid oxidation to glucose oxidation as a source of cardiac energy and therefore, improves cardiac efficiency,” explained Komajda. “Potentiation of glucose oxidation optimizes cellular energy processes, maintaining proper energy metabolism during ischaemia.”

Despite advances in pharmacotherapy and revascularization strategies, SCAD or stable ischaemic heart disease, remains associated with poor quality of life, poor outcomes, and disability, said Komajda.

“A significant proportion of patients revascularized by angioplasty still complain of angina pectoris, reflecting an impairment of coronary blood flow,” “One of three chronic stable angina outpatients remains symptomatic and at high risk of cardiovascular [CV] events.”  

Treatment options vary with the precise cause, and relevant to increased myocardial oxygen demand as against reduced supply. Current guidelines on SCAD by the European Society of Cardiology (ESC) recommend the use of ACE inhibitors, statins and aspirin, and medication relieving symptoms to prevent CV events, including acute coronary syndromes, in patients most of whom will experience angina as part of the disease’s clinical manifestations. The pharmacological therapy is in addition to lifestyle changes and risk factor control. [Eur Heart J 2013;34:2949-3003]

“Angina occurs when myocardial oxygen demand exceeds oxygen supply. Trimetazidine, and other anti-ischaemic agents, is being used for second-line treatment and for the control of stable angina episodes,” said Komajda.

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