Trimetazidine added to beta-blocker improves control of stable angina

NEW YORK (Reuters Health) – Compared with metoprolol alone, the addition of trimetazidine significantly improves exercise tolerance in patients with stable angina, Polish researchers report.

Dr. Hanna Szwed from the National Institute of Cardiology, Warsaw, and colleagues note in the December 2001 issue of the European Heart Journal that while most traditional antianginal drugs act hemodynamically, "there is another class of drugs, the metabolic agents, which protect the myocardium from ischaemic injury by directly modifying the use of energy substrates in the heart."

To test the combination of such agents, the researchers randomly assigned 426 men and women with effort-induced angina and diagnosed coronary artery disease, to metoprolol 50 mg twice daily and placebo or to metoprolol 50 mg twice daily plus the metabolic agent, trimetazidine, 20 mg three times a day.

After 12 weeks, among the 347 patients who completed the trial, those receiving metoprolol and trimetazidine had significantly greater improvement than those on metoprolol alone in time to 1 mm ST segment depression, time to angina onset, and maximum ST segment depression on exercise testing (p < 0.01).

The combination patients also had significantly fewer mean weekly number of angina attacks and greater reductions in mean weekly nitrate use (p < 0.05), Dr. Szwed's group reports.

The investigators conclude that "it is clear that the metabolic effect of trimetazidine, devoid of any hemodynamic action provides a new approach to the treatment of stable angina pectoris. In particular, as confirmed by these results, trimetazidine is useful for combination therapy in patients insufficiently controlled by monotherapy with a beta-blocker."

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