Stable angina pectoris, a symptom of
coronary heart disease (CHD), manifests as stress-induced ischaemic episodes resulting in severe
chest pain. Therapeutic aims are to improve quality of life by decreasing anginal attacks and to prevent
myocardial infarction (MI) and death. Current anginal medications include beta-blockers and
calcium antagonists, which decrease ischaemic severity by reducing cardiac workload, and
nitrates, which increase coronary blood flow. A new therapeutic approach is the use of metabolic agents, such as
trimetazidine, which are cytoprotective during ischaemia. Results of several clinical trials demonstrated that
trimetazidine, at the standard dose of 20 mg t.i.d., increased exercise capacity, decreased anginal incidence and decreased left-ventricular (
LV) dysfunction compared to placebo.
Trimetazidine was also as effective as
propranolol (120 - 160 mg/day) and
nifedipine (40 mg/day) in decreasing anginal episodes and improving exercise parameters.
Trimetazidine improved anginal frequency and symptoms in patients in which treatment with
diltiazem,
nifedipine,
propranolol,
pindolol,
oxprenolol or long-acting
nitrates had failed.
Trimetazidine was also more effective than
isosorbide dinitrate (30 mg/day) as an adjunct to
propranolol. Despite efficacy being equivalent to that of beta-blockers and
calcium antagonists,
trimetazidine does not depress cardiac function and, correspondingly, is not contraindicated in any condition. Adverse effects of
trimetazidine are mild and infrequent. In summary, clinical data indicate that
trimetazidine is a safe, effective treatment for the symptoms of
stable angina pectoris when used either as a monotherapy or an adjunctive
therapy. Longer-term trials are necessary to determine whether
trimetazidine will be effective in reducing rates of mortality and MI.