Invited review
Anti-inflammatory effects of trimetazidine in patients with ischemic heart disease

Recent studies have demonstrated that alterations in cardiac metabolism occur in ischemic heart disease and heart failure. This suggests that there is an increased utilization of non-carbohydrate substrates for energy production with a resultant reduction in the efficiency of myocardial oxygen consumption. A direct approach to modifying cardiac energy metabolism could involve altering substrate utilization. Trimetazidine, which acts by selectively inhibiting mitochondrial 3-ketoacyl-coenzyme A thiolase, (an enzyme involved in b-oxidation) is an antianginal drug that shifts the preference for energy substrate away from fatty acid metabolism and towards glucose metabolism. It has a reduces ischemia-reperfusion damage and left ventricular function by reducing cell damage, tissue inflammation and left ventricle remodeling. Recent research has demonstrated that the anti-inflammatory action of trimetazidine reduces long-term mortality in patient with ischemic cardiomyopathy.