Lege Artis Medicinae

[THERAPY WITH TRIMETAZIDINE IN DIABETIC PATIENTS WITH CORONARY DISEASE]

NAGY András

NOVEMBER 30, 2006

Lege Artis Medicinae - 2007;17(02 klsz)

[In the diabetic heart the efficacy of haemodynamic agents is limited due to vascular stiffness. Metabolic drugs such as trimetazidine switch energy production from fatty acid oxidation typical to diabetes to the more efficient glycolysis. The improved energy production increases contractility. Three studies have been conducted with trimetazidine in patients with comorbid diabetes and coronary artery disease. In these, trimetazidine improved left ventricular function without modifying heart rate or blood pressure. Markers of glycaemic control also improved. Trimetazidine also reduced the levels of circulating endothelin-1. In conclusion, trimetazidine is a safe and effective drug that improves both myocardial function and glycaemic control in patients with coexisting diabetes and coronary artery disease.]

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[Coronary heart disease has traditionally been treated by haemodynamic agents including beta-blockers, calcium channel blockers and nitrates. Trimetazidine, which shifts myocardial energy metabolism from fatty acid oxidation towards glucose oxidation, thereby providing a more efficient oxygen utilization, represents a new, metabolic approach in the medical treatment of this condition. The present review gives an overview of recent studies on the beneficial effects of trimetazidine in severely or moderately impaired left ventricular function. In addition to the parameters that characterize left ventricular ejection function and the to the improvement of clinical symptoms, the beneficial effects of trimetazidine after coronary angioplasty and in the older age are also discussed. Treatment is safe and the efficacy is maintained in the long-term.]

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[Ivabradine is a new agent that selectively inhibits the If channels of the sinus node. Electrophysiological studies have shown a significant heart rate lowering effect of ivabradine compared to placebo, while no significant changes have been observed in the frequency-corrected QT interval (QTc) or in the conductivity or refractoriness of the atrial muscle, AV node, His- Purkinje system or ventricular muscle. In a noninferiority study that compared ivabradine to atenolol, the same efficacy was shown in terms of increasing effort tolerance and reducing anginal events, with less reduction in heart rate. The same results were obtained with the comparison to amlodipine - the two drugs were equally efficient. The longest trial investigated the efficacy and safety of ivabradine for 12 month; both heart rate and the number of anginal episodes significantly decreased during the entire study period. The ongoing BEAUTIFUL trial tests ivabradine in patients with heart failure. The only important side effect of ivabradine is phosphenes, but this rarely requires the treatment to be discontinued. No other side effects such as symptomatic bradycardia or conduction abnormalities have been observed. Ivabradine is currently indicated as an alternative treatment of stable angina pectoris.]

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