Benefits of adding a energetic agent to  -blockers to achieve optimal reduction of angina. Review of the main studies.

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Presentation transcript:

Benefits of adding a energetic agent to  -blockers to achieve optimal reduction of angina. Review of the main studies

Is coronary obstruction the only player in ischemic heart disease? Sambuceti G. Eur J Nucl Med Mol Imaging. 2005;32:

Is coronary obstruction the only player in ischemic heart disease? Cheng VY, et al. Circulation. 2011;124:

Marzilli M, et al. J Am Coll Cardiol. 2012;60: Myocardial ischemia is multifactorial

Marzilli M, et al. J Am Coll Cardiol 2012;60:951–6. Ischemia is an energy deficiency

Increased energy in the ischemic heart Fragasso G, et al. Eur Heart J. 2006;27:

Cellular energy balance Act on both sides of the cellular energy balance To protect the cells from ischemia, the energy supply needs to remain greater than the energy demand.

Time to 1-mm ST depression Trimetazidine Placebo Time to onset of angina Angina attacks/week (n)Nitrate use / week (n) n=426 Stable angina patients All on metoprolol (50 mg/day) Szwed H, et al. TRIMPOL II Eur Heart J. 2001;22: P<0.01 NS W0W Time (s) Angina attacks W0W12 NS P<0.01 W0W12 Time (s) NS P< Mean nitrate use / week (n) W0W12 NS P<0.01 Proven antianginal efficacy with  -blockers

Michaelides AP, et al. Clin Drug Invest. 1997;13:8-14. n=53 Stable angina patients uncontrolled with Propranolol 40 mg/day

Proven antianginal efficacy with  -blockers Nesukay E, et al. ESC Abstract

Conclusions Chronic ischemic heart disease (IHD) is still a significant clinical burden IHD results from a number of mechanisms To ensure optimal management of IHD on top of  -blockers, it is essential to address the energetic origin of ischemia Trimetazidine MR is an effective drug to use in combination with β-blockers to relieve angina effectively.