Effect of free fatty acid inhibition on silent and symptomatic myocardial ischemia in diabetic patients with coronary artery disease

Giuseppe Marazzi, Mauricio Wajngarten, Cristiana Vitale, Roberto Patrizi, Francesco Pelliccia, Otavio Gebara, Humberto Pierri, Josè Antonio F Ramires, Maurizio Volterrani, Massimo Fini, Giuseppe M C Rosano

Research output: Contribution to journalArticle

Abstract

Objective: Free fatty acid inhibition with trimetazidine (TMZ) improves myocardial metabolism and myocardial ischemia in patients with coronary artery disease (CAD). Because of its effect on myocardial glucose utilization TMZ may represent a therapeutic option in diabetic patients with CAD. Aim of the present study was to evaluate whether the metabolic effect of TMZ may improve episodes of myocardial ischemia in diabetic patients with CAD. Research design and methods: We assessed the effect of TMZ on 24 h ambulatory ECG monitoring (AEM) in 30 patients (22 males and 8 females, mean (SE) age 67 ± 6.5 years) with NIDDM and ischemic cardiomyopathy. Patients were randomized to receive on top of standard therapy either TMZ (20 mg, tds) or placebo (tds) and were evaluated at baseline and after 6 months. Results: Patients randomized to TMZ or placebo were comparable regarding demographic data, distribution of CAD, and glicated haemoglobin levels. TMZ significantly reduced the number of episodes of transient myocardial ischemia (- 24% compared to baseline, p <0.01; - 27% compared to placebo, p <0.01), and Total Ischemic Burden (- 28% compared to baseline, p <0.01; - 29% compared to placebo, p <0.01). TMZ also significantly reduced the number of silent episodes of myocardial ischemia (- 42% compared to baseline and - 39% compared to placebo, p <0.01) and the time of silent myocardial ischemia/24 h (- 37% compared to baseline and - 35% compared to placebo, p <0.01). No significant changes in heart rate were detected between baseline, placebo and TMZ evaluations. Conclusions: TMZ is effective in reducing silent and symptomatic episodes of transient myocardial ischemia in diabetic patients with CAD on standard anti-anginal therapy.

Original languageEnglish
Pages (from-to)79-84
Number of pages6
JournalInternational Journal of Cardiology
Volume120
Issue number1
DOIs
Publication statusPublished - Aug 9 2007

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Trimetazidine
Nonesterified Fatty Acids
Myocardial Ischemia
Coronary Artery Disease
Placebos
Ambulatory Monitoring
Cardiomyopathies
Type 2 Diabetes Mellitus
Electrocardiography
Hemoglobins
Research Design
Therapeutics
Heart Rate

Keywords

  • Diabetes mellitus
  • Myocardial ischema
  • Prognosis
  • Therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of free fatty acid inhibition on silent and symptomatic myocardial ischemia in diabetic patients with coronary artery disease. / Marazzi, Giuseppe; Wajngarten, Mauricio; Vitale, Cristiana; Patrizi, Roberto; Pelliccia, Francesco; Gebara, Otavio; Pierri, Humberto; Ramires, Josè Antonio F; Volterrani, Maurizio; Fini, Massimo; Rosano, Giuseppe M C.

In: International Journal of Cardiology, Vol. 120, No. 1, 09.08.2007, p. 79-84.

Research output: Contribution to journalArticle

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abstract = "Objective: Free fatty acid inhibition with trimetazidine (TMZ) improves myocardial metabolism and myocardial ischemia in patients with coronary artery disease (CAD). Because of its effect on myocardial glucose utilization TMZ may represent a therapeutic option in diabetic patients with CAD. Aim of the present study was to evaluate whether the metabolic effect of TMZ may improve episodes of myocardial ischemia in diabetic patients with CAD. Research design and methods: We assessed the effect of TMZ on 24 h ambulatory ECG monitoring (AEM) in 30 patients (22 males and 8 females, mean (SE) age 67 ± 6.5 years) with NIDDM and ischemic cardiomyopathy. Patients were randomized to receive on top of standard therapy either TMZ (20 mg, tds) or placebo (tds) and were evaluated at baseline and after 6 months. Results: Patients randomized to TMZ or placebo were comparable regarding demographic data, distribution of CAD, and glicated haemoglobin levels. TMZ significantly reduced the number of episodes of transient myocardial ischemia (- 24{\%} compared to baseline, p <0.01; - 27{\%} compared to placebo, p <0.01), and Total Ischemic Burden (- 28{\%} compared to baseline, p <0.01; - 29{\%} compared to placebo, p <0.01). TMZ also significantly reduced the number of silent episodes of myocardial ischemia (- 42{\%} compared to baseline and - 39{\%} compared to placebo, p <0.01) and the time of silent myocardial ischemia/24 h (- 37{\%} compared to baseline and - 35{\%} compared to placebo, p <0.01). No significant changes in heart rate were detected between baseline, placebo and TMZ evaluations. Conclusions: TMZ is effective in reducing silent and symptomatic episodes of transient myocardial ischemia in diabetic patients with CAD on standard anti-anginal therapy.",
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AU - Marazzi, Giuseppe

AU - Wajngarten, Mauricio

AU - Vitale, Cristiana

AU - Patrizi, Roberto

AU - Pelliccia, Francesco

AU - Gebara, Otavio

AU - Pierri, Humberto

AU - Ramires, Josè Antonio F

AU - Volterrani, Maurizio

AU - Fini, Massimo

AU - Rosano, Giuseppe M C

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AB - Objective: Free fatty acid inhibition with trimetazidine (TMZ) improves myocardial metabolism and myocardial ischemia in patients with coronary artery disease (CAD). Because of its effect on myocardial glucose utilization TMZ may represent a therapeutic option in diabetic patients with CAD. Aim of the present study was to evaluate whether the metabolic effect of TMZ may improve episodes of myocardial ischemia in diabetic patients with CAD. Research design and methods: We assessed the effect of TMZ on 24 h ambulatory ECG monitoring (AEM) in 30 patients (22 males and 8 females, mean (SE) age 67 ± 6.5 years) with NIDDM and ischemic cardiomyopathy. Patients were randomized to receive on top of standard therapy either TMZ (20 mg, tds) or placebo (tds) and were evaluated at baseline and after 6 months. Results: Patients randomized to TMZ or placebo were comparable regarding demographic data, distribution of CAD, and glicated haemoglobin levels. TMZ significantly reduced the number of episodes of transient myocardial ischemia (- 24% compared to baseline, p <0.01; - 27% compared to placebo, p <0.01), and Total Ischemic Burden (- 28% compared to baseline, p <0.01; - 29% compared to placebo, p <0.01). TMZ also significantly reduced the number of silent episodes of myocardial ischemia (- 42% compared to baseline and - 39% compared to placebo, p <0.01) and the time of silent myocardial ischemia/24 h (- 37% compared to baseline and - 35% compared to placebo, p <0.01). No significant changes in heart rate were detected between baseline, placebo and TMZ evaluations. Conclusions: TMZ is effective in reducing silent and symptomatic episodes of transient myocardial ischemia in diabetic patients with CAD on standard anti-anginal therapy.

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