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Benefits of adding a energetic agent to -blockers to achieve optimal reduction of angina. Review of the main studies
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Is coronary obstruction the only player in ischemic heart disease? Sambuceti G. Eur J Nucl Med Mol Imaging. 2005;32:385-388.
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Is coronary obstruction the only player in ischemic heart disease? Cheng VY, et al. Circulation. 2011;124:2423-2432.
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Marzilli M, et al. J Am Coll Cardiol. 2012;60:951-956. Myocardial ischemia is multifactorial
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Marzilli M, et al. J Am Coll Cardiol 2012;60:951–6. Ischemia is an energy deficiency
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Increased energy in the ischemic heart Fragasso G, et al. Eur Heart J. 2006;27:942-948.
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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.
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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;22:2367-2374. P<0.01 NS W0W12 450 400 350 300 Time (s) 5 2 1 0 4 3 Angina attacks W0W12 NS P<0.01 W0W12 Time (s) NS P<0.01 500 400 350 300 450 4 2 1 0 3 Mean nitrate use / week (n) W0W12 NS P<0.01 Proven antianginal efficacy with -blockers
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Michaelides AP, et al. Clin Drug Invest. 1997;13:8-14. n=53 Stable angina patients uncontrolled with Propranolol 40 mg/day
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Proven antianginal efficacy with -blockers Nesukay E, et al. ESC 2013. Abstract 86728.
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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.
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