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Proposed Antiischemic Effects of Trimetazidine in Coronary Diabetic Patients. A Substudy from TRIMPOL-1

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Abstract

Summary. Diabetes mellitus, a disease with a wide prevalence, has major cardiovascular effects, being a risk factor for the development of ischemic heart disease and congestive heart failure. The aim of this open, multicenter study was to assess the antiischemic efficacy and tolerability of trimetazidine, a metabolic agent acting at the myocardial mitochondrial level, in diabetic patients with stable effort angina treated previously with a single conventional antianginal drug. Fifty diabetic patients (mean age 58 years) with proven coronary artery disease, stable effort angina for at least 3 months, and positive, comparable results of two initial treadmill exercise tests separated by a 1-week interval were included in the study. They continued their conventional antianginal monotherapy with a long-acting nitrate, beta-blocker, or calcium channel blocker. After stabilization, 4-week therapy with trimetazidine, three times daily, 20 mg was initiated in combination with previous treatment. The results showed a significant improvement in exercise tolerance (440.2 vs. 383.2 s; P < 0.01), time to 1-mm ST-segment depression (358.3 vs. 301.6 s; P < 0.01), time to onset of anginal pain (400.0 vs. 238.3 s; P < 0.01), and total work (9.39 vs. 8.67 metabolic equivalents, P < 0.01). Maximal ST-segment depression was attenuated compared with baseline (1.82 vs. 1.91 mm). Other findings included a significant decrease in the mean frequency of anginal episodes (3.06 vs. 4.79 per week; P < 0.01) and in mean nitrate consumption (2.29 vs. 4.2 doses/week). These results suggest that trimetazidine may be effective and is well tolerated as combination therapy for diabetic coronary artery disease patients uncontrolled with a single hemodynamic agent.

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Authors and Affiliations

  1. National Institute of Cardiology, Warsaw

    Hanna Szwed & Zygmunt Sadowski

  2. Servier-Polska, Warsaw

    Robert Pachocki & Małgorzata Domżał-Bocheńska

  3. Voivodeship Cardiological Center, Łomża

    Krzysztof Szymczak

  4. City Hospital, PCK, Bialystok

    Zbigniew Szydłowski

  5. Department of Ischaemic Heart Disease, Collegium Medicum Jagiellonian University, Poland

    Andrzej Paradowski

  6. Department of Cardiology, Collegium Medicum Jagiellonian University, Cracow

    Grzegorz Gajos & Grzegorz Kałuża

  7. Voivodeship Specialistic Hospital, G Narutowicza, Cracow

    Irena Kulon

  8. Voivodeship Cardiological Center, Cracow

    Anna Wątor-Brzezińska

  9. Strusia Hospital, Poznań

    Waldemar Elikowski

  10. District Hospital, Olesno, Poland

    Maria Kuźniak

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  1. Hanna Szwed
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  8. Grzegorz Gajos
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  13. Maria Kuźniak
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Szwed, H., Sadowski, Z., Pachocki, R. et al. Proposed Antiischemic Effects of Trimetazidine in Coronary Diabetic Patients. A Substudy from TRIMPOL-1. Cardiovasc Drugs Ther 13, 217–222 (1999). https://doi.org/10.1023/A:1007744109064

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