Effectiveness and safety of anti-ischemic trimetazidine in patients with stable angina pectoris and Type 2 diabetes

Abstract

Aim & methods: This 6-month prospective, observational, noninterventional, open-label clinical study assessed the effectiveness/safety of trimetazidine in 737 patients with stable angina pectoris and Type 2 diabetes mellitus (OGYI/51534–1/2014). Results: Trimetazidine-based therapy was effective in stable coronary artery disease, with significant improvements from baseline (p < 0.05) in: number of angina attacks/week (2.9 ± 2.4 vs 1.1 ± 1.6), angina severity (Canadian Cardiovascular Society Classification 1.9 ± 0.8 vs 1.2 ± 0.8), exercise capacity (metabolic equivalents 6.1 ± 1.7 vs 6.5 ± 1.7), and exercise-induced myocardial ischemia (min 5.5 ± 2.5 vs 6.5 ± 2.6). Discussion: Trimetazidine treatment significantly (p < 0.05) improved glucose metabolism, lowered HbA1c (7.1 ± 1.1% vs 6.6 ± 1.0%), glucose levels (7.7 ± 2.1 mmol/l vs 6.9 ± 1.6 mmol/l) and decreased arterial stiffness (pulse wave velocity 11.2 ± 2.1 m/s vs 10.4 ± 2.2 m/s). In most patients, the tolerability of trimetazidine was rated as excellent to good, with a low incidence of adverse events.

Trimetazidine in Heart Failure

“…Clinical pharmacological studies suggest that although common adverse reactions of trimetazidine can be found occasionally, such as gastrointestinal discomfort, nausea and vomiting, and rarely reported thrombocytopenia, agranulocytosis, and liver dysfunction (Chrusciel et al, 2014), these adverse reactions tend to disappear after withdrawal (Meiszterics et al, 2017). In the past, there was a concern that trimetazidine might be linked to Parkinson-like syndrome.…”

Altered mitochondrial metabolism in the insulin‐resistant heart

“…Trimetazidine and ranolazine are clinically used as antianginal agents. Growing evidence suggests that trimetazidine treatment can reduce the severity of adverse cardiovascular events in both experimental models of insulin resistance and in patients with T2DM . It was first proposed that trimetazidine inhibits FA metabolism in cardiac mitochondria by inhibiting long‐chain 3‐ketoacyl CoA thiolase (the last enzyme in the β‐oxidation pathway).…”

“…Growing evidence suggests that trimetazidine treatment can reduce the severity of adverse cardiovascular events in both experimental models of insulin resistance and in patients with T2DM. [280][281][282] It was first proposed that trimetazidine inhibits FA metabolism in cardiac mitochondria by inhibiting long-chain 3-ketoacyl CoA thiolase (the last enzyme in the β-oxidation pathway). More recently, however, it has been demonstrated that trimetazidine does not alter metabolic substrate oxidation in the cardiac mitochondria of T2DM patients.…”

Natural Magnesium-Enriched Deep-Sea Water Improves Insulin Resistance and the Lipid Profile of Prediabetic Adults: A Randomized, Double-Blinded Crossover Trial

“…Thus, diabetes is not just a health crisis, but a global disaster [1]. Diabetes itself is dangerous and unless adequate treatment is provided, diverse and serious complications such as diabetic retinopathy [2], stroke [3], chronic renal failure [4], angina pectoris [5], and myocardial infarction [6] can cause a decrease in quality of life and lead to patient death.…”