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

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.