Difficulties of antianginal therapy selecting in an elderly polymorbid patient with coronary heart disease


DOI: https://dx.doi.org/10.18565/therapy.2024.9.130-139

Kochetkov A.I., Telkova S.S., Dubinina A.V., Mironova E.V., Filippova T.V., Ostroumova O.D.

1) Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia, Moscow; 2) Central Clinical Hospital “RZhD-Medicine”, Moscow; 3) I.M. Sechenov First Moscow Medical University of the Ministry of Healthcare of Russia (Sechenov University)
Abstract. Coronary heart disease (СHD) is a significant problem of modern medicine. Even with the increasing of the frequency of revascularization among patients with such type of disease, the necessity for antianginal therapy prescription remains to be high enough. According to clinical guidelines, two lines of drugs are indicated for the treatment of exertional angina. First-line drugs have anti-ischemic effect due to vasodilation or slowing of the heart rate, i.e. their efficacy is limited by the functional reserves of the myocardium during ischemia. The aim of the represented clinical analysis is to demonstrate the possibilities of a personalized approach to the management of exertional angina patients. Addition of prolonged-release trimetazidine in a single dose of 70 mg (Deprenorm® OD) 1 time per day to the ongoing antianginal therapy led to increase of the antianginal effect and improvement of life quality of the observed patient. A single dose of this medicine increases patient compliance with therapy, which allows us to consider its use as an optimal therapeutic option for СHD treatment.
Keywords: exertional angina, polymorbidity, antianginal therapy, trimetazidine, coronary heart disease
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Literature

1. Roth G.A., Mensah G.A., Johnson C.O. et al.; GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group Global burden of cardiovascular diseases and risk factors, 1990–2019: Update from the GBD 2019 study. J Am Coll Cardiol. 2020; 76(25): 2982–3021.


https://doi.org/.1016/j.jacc.2020.11.010. PMID: 33309175. PMCID: PMC7755038.


2. Здравоохранение в России, 2023: статистический сборник. М.: Росстат. 2023: 171. Доступ: https://rosstat.gov.ru/storage/mediabank/Zdravooxran_2023.htm (дата обращения – 13.11.2024). (Healthcare in Russia, 2023: Statistical collection. Moscow: Rosstat. 2023: 171. URL: https://rosstat.gov.ru/storage/mediabank/Zdravooxran_2023.htm (date of access – 13.11.2024) (In Russ.)).


3. Барбараш О.Л., Карпов Ю.А., Кашталап В.В. с соавт. Российское кардиологическое общество. Стабильная ишемическая болезнь сердца. Клинические рекомендации 2020. Российский кардиологический журнал. 2020; 25(11): 201–250. (Barbarash O.L., Karpov Yu.A., Kashtalap V.V. et al. 2020 Clinical practice guidelines for Stable coronary artery disease. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2020; 25(11): 201–250 (In Russ.)).


https://doi.org/10.15829/29/1560-4071-2020-4076. EDN: THCMQS.


4. Mensah G.A. Brown D.W. An overview of cardiovascular disease burden in the United States. Health Aff (Millwood). 2007; 26(1) 38–48.


https://doi.org/10.1377/hlthaff.26.1.38. PMID: 17211012.


5. WRITING GROUP MEMBERS; Lloyd-Jones D., Adams R.J., Brown T.M. et al. Heart disease and stroke statistics – 2010 update: A report from the American Heart Association. Circulation. 2010; 121(7): e46–e215.


https://doi.org/10.1161/circulationaha.109.192667. PMID: 20019324.


6. Карпов Ю.А., Сорокин Е.В. Стабильная ишемическая болезнь сердца: стратегия и тактика лечения. 2-е изд., перераб. и доп. М.: Медицинское информационное агентство, 2012; 271 с. (Karpov Yu.A., Sorokin E.V. Stable coronary heart disease: Strategy and tactics of treatment. 2nd ed., reprint. and additional. Moscow: Medical Information Agency. 2012; 271 pp. (In Russ.)). ISBN: 978-5-9986-0080-7.


7. Карпов Ю.А., Кухарчук В.В., Лякишев А. с соавт. Диагностика и лечение хронической ишемической болезни сердца. Практические рекомендации. Кардиологический вестник. 2015; 10(3): 3–33. (Karpov Yu.A., Kukharchuk V.V., Lyakishev A. et al. Diagnosis and treatment of chronic coronary heart disease. Practical recommendations. Kardiologicheskiy vestnik = Cardiology Bulletin. 2015; 10(3): 3–33 (In Russ.)). EDN: UKKHIJ.


8. Simoons M.L., Windecker S. Controversies in cardiovascular medicine: Chronic stable coronary artery disease: Drugs vs revascularization. Eur Heart J. 2010; 31(5): 530–41.


https://doi.org/10.1093/eurheartj/ehp605. PMID: 20106842.


9. Hemingway H., Crook A.M., Feder G. et al. Underuse of coronary revascularization procedures in patients considered appropriate candidates for revascularization. N Engl J Med. 2001; 344(9): 645–54.


https://doi.org/10.1056/nejm200103013440906. PMID: 11228280.


10. Cartlidge T., Kovacevic M., Navarese E.P. et al. Role of percutaneous coronary intervention in the modern-day management of chronic coronary syndrome. Heart. 2023; 109(19): 1429–35.


https://doi.org/10.1136/heartjnl-2022-321870. PMID: 36928242.


11. Bittl J.A., He Y., Jacobs A.K. et al. American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines. Bayesian methods affirm the use of percutaneous coronary intervention to improve survival in patients with unprotected left main coronary artery disease. Circulation. 2013; 127(22): 2177–85.


https://doi.org/10.1161/circulationaha.112.000646. PMID: 23674397.


12. Pursnani S., Korley F., Gopaul R. et al. Percutaneous coronary intervention versus optimal medical therapy in stable coronary artery disease: A systematic review and meta-analysis of randomized clinical trials. Circ Cardiovasc Interv. 2012; 5(4): 476–90.


https://doi.org/10.1161/circinterventions.112.970954. PMID: 22872053.


13. Holubkov R., Laskey W.K., Haviland A. et al. Angina 1 year after percutaneous coronary intervention: A report from the NHLBI Dynamic Registry. Am Heart J. 2002; 144(5): 826–33.


https://doi.org/10.1067/mhj.2002.125505. PMID: 12422151.


14. Wijeysundera H.C., Nallamothu B.K., Krumholz H.M. et al. Meta-analysis: Effects of percutaneous coronary intervention versus medical therapy on angina relief. Ann Intern Med. 2010; 152(6): 370–79.


https://doi.org/10.7326/0003-4819-152-6-201003160-00007. PMID: 20231568.


15. Vrints C., Andreotti F., Koskinas K.C. et al.; ESC Scientific Document Group 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024; 45(36): 3415–537.


https://doi.org/10.1093/eurheartj/ehae177. PMID: 39210710.


16. Manolis A.J., Poulimenos L.E., Ambrosio G. et al. Medical treatment of stable angina: A tailored therapeutic approach. Int J Cardiol. 2016; 220: 445–53. https://doi.org/10.1016/j.ijcard.2016.06.150. PMID: 27390968.


17. Ferrari R., Pavasini R., Camici P.G. et al. Anti-anginal drugs-beliefs and evidence: Systematic review covering 50 years of medical treatment. Eur Heart J. 2019; 40(2): 190–94.


https://doi.org/10.1093/eurheartj/ehy504. PMID: 30165445.


18. Balla C., Pavasini R., Ferrari R. Treatment of angina: Where are we? Cardiology. 2018; 140(1): 52–67.


https://doi.org/10.1159/000487936. PMID: 29874661.


19. Ciapponi A., Pizarro R., Harrison J. Trimetazidine for stable angina. Cochrane Database Syst Rev. 2005; (4): CD003614.


https://doi.org/10.1002/14651858.CD003614.pub2. PMID: 16235330.


20. Stanley W.C., Recchia F.A., Lopaschuk G.D. Myocardial substrate metabolism in the normal and failing hear. Physiol Rev. 2005; 85(3): 1093–129.


https://doi.org/10.1152/physrev.00006.2004. PMID: 15987803.


21. Taqueti V.R., Di Carli M.F. Coronary microvascular disease pathogenic mechanisms and therapeutic options: JACC State-of-the-Art review. J Am Coll Cardiol. 2018; 72(21): 2625–41.


https://doi.org/10.1016/j.jacc.2018.09.042. PMID: 30466521. PMCID: PMC6296779.


22. Timmis A., Townsend N., Gale C. et al.; ESC Scientific Document Group. European Society of Cardiology: Cardiovascular disease statistics 2017. Eur Heart J. 2018; 39(7): 508–79.


https://doi.org/10.1093/eurheartj/ehx628. PMID: 29190377.


23. Kunadian V., Chieffo A., Camici P.G. et al. An EAPCI Expert Consensus document on ischaemia with non-obstructive coronary arteries in collaboration with European Society of Cardiology Working Group on coronary pathophysiology & microcirculation endorsed by Coronary Vasomotor Disorders International Study Group. Eur Heart J. 2020; 41(37): 3504–20.


https://doi.org/10.1093/eurheartj/ehaa503. PMID: 32626906. PMCID: PMC7577516.


24. Pillutla P., Hwang Y.C., Augustus A. et al. Perfusion of hearts with triglyceride-rich particles reproduces the metabolic abnormalities in lipotoxic cardiomyopathy. Am J Physiol Endocrinol Metab. 2005; 288(6): 1229–35.


https://doi.org/10.1152/ajpendo.00273.2004. PMID: 15701679.


25. Di Napoli P., Taccardi A.A., Barsotti A. Long term cardioprotective action of trimetazidine and potential effect on the inflammatory process in patients with ischaemic dilated cardiomyopathy. Heart. 2005; 91(2): 161–65.


https://doi.org/10.1136/hrt.2003.031310. PMID: 15657223. PMCID: PMC1768679.


26. Сизова Ж.М., Владимиров С.К. Современные возможности миокардиальной цитопротекции в лечении больных ишемической болезнью сердца. Медицинский совет. 2016; (13): 38–43. (Sizova Zh.M., Vladimirov S.K. Modern peculiarities of myocardial cytoprotection in therapy of ishemic heart disease patients. Meditsinskiy sovet = Medical Council. 2016; (13): 38–43 (In Russ.)).


https://doi.org/10.21518/2079-701X-2016-13-38-43. EDN: XUYANT.


27. Lee L., Horowitz J., Frenneaux M. Metabolic manipulation in ischaemic heart disease, a novel approach to treatment. Eur Heart J. 2004; 25(8): 634–41.


https://doi.org/10.1016/j.ehj.2004.02.018. PMID: 15084367.


28. Peng S., Zhao M., Wan J. et al. The efficacy of trimetazidine on stable angina pectoris: A meta-analysis of randomized clinical trials. Int J Cardiol. 2014; 177(3): 780–85.


https://doi.org/10.1016/j.ijcard.2014.10.149. PMID: 25466565.


29. Vitale C., Spoletini I., Malorni W. et al. Efficacy of trimetazidine on functional capacity in symptomatic patients with stable exertional angina – the VASCO-angina study. Int J Cardiol. 2013; 168(2): 1078–81.


https://doi.org/10.1016/j.ijcard.2012.11.001. PMID: 23200272.


30. Michaelides A.P., Spiropoulos K., Dimopoulos K. et al. Antianginal efficacy of the combination of trimetazidine-propranolol compared with isosorbide dinitrate-propranolol in patients with stable angina. Clin Drug Invest. 1997; 13: 8–14.


https://doi.org/10.2165/00003495-200767030-00005.


31. Ruzyllo W., Szwed H., Sadowski Z. et al. Efficacy of trimetazidine in patients with recurrent angina: A subgroup analysis of the TRIMPOL II study. Curr Med Res Opin. 2004; 20(9): 1447–54.


https://doi.org/10.1185/030079904X2637. PMID: 15383193.


32. Симаков А.А., Панина М.И. Новые возможности лечения больных с ишемической болезнью сердца и стабильной стенокардией. Медицинский совет. 2016; (19): 6–11. (Simakov A.A., Panina M.I. New treatment options for patients with coronary artery disease and stable angina pectoris. Meditsinskiy sovet = Medical Council. 2016; (19): 6–11 (In Russ.)).


https://doi.org/10.21518/2079-701X-2016-19-6-11. EDN: XHUWCF.


33. Leonova I.A., Boldueva S., Zakharova O. et al. Trimetazidine improves symptoms and reduces microvascular dysfunction in patients with microvascular angina. Eur Heart J. 2017; 38(suppl 1): 198.


https://doi.org/10.1093/eurheartj/ehx501.P887.


34. Ромащенко О.В., Клочкова Г.Н., Муханова Е.И., Гайворонская И.В. Плейотропные эффекты триметазидина. Российский кардиологический журнал. 2013; 18(4): 83–87. (Romashchenko O.V., Klochkova G.N., Mukhanova E.I., Gaivoronskaya I.V. Pleiotropic effects of trimetazidine. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2013; 18(4): 83–87 (In Russ.)).


https://doi.org/10.15829/1560-4071-2013-4-83-87. EDN: RBJJFX.


35. Shehata M. Impact of trimetazidine on incidence of myocardial injury and contrast-induced nephropathy in diabetic patients with renal dysfunction undergoing elective percutaneous coronary intervention. Am J Cardiol. 2014; 114(3): 389–94.


https://doi.org/10.1016/j.amjcard.2014.04.052. PMID: 24927970.


36. Марцевич С.Ю., Кутишенко Н.П., Гинзбург М.Л. с соавт. Исследование КАРДИОКАНОН: способ решения вопроса о клинической эквивалентности оригинальных и воспроизведенных препаратов. Рациональная фармакотерапия в кардиологии. 2012; 8(2): 179–184. (Martsevich S.Yu., Kutishenko N.P., Ginzburg M.L. et al. CARDIOCANON research: A way to resolve the issue of clinical equivalence of original and reproduced drugs. Ratsional’naya farmakoterapiya v kardiologii = Rational Pharmacotherapy in Cardiology. 2012; 8(2): 179–184 (In Russ.)).


https://doi.org/10.20996/1819-6446-2012-8-2-54-55. EDN: QCVOKL.


About the Autors

Alexey I. Kochetkov, MD, PhD (Medicine), associate professor, associate professor of the Department of therapy and polymorbid pathology named after academician M.S. Vovsi, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 125993, Moscow, 2/1 build.1 Barrikadnaya St.
E-mail: ak_info@list.ru
ORCID: https://orcid.org/0000-0001-5801-3742. eLibrary SPIN: 9212-6010
Svetlana S. Telkova, MD, 1st year postgraduate student, senior laboratory assistant at the Department of therapy and polymorbid pathology named after academician M.S. Vovsi, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 125993, Moscow, 2/1 build.1 Barrikadnaya St.
E-mail: svetlana.t03@yandex.ru
ORCID: https://orcid.org/0000-0003-1439-7371. eLibrary SPIN: 1755-1594
Anna V. Dubinina, MD, 2nd year postgraduate student of the Department of therapy and polymorbid pathology named after academician M.S. Vovsi, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 125993, Moscow, 2/1 build.1 Barrikadnaya St.
E-mail: dubinina_anna2023@mail.ru
ORCID: https://orcid.org/0009-0008-6383-0016
Elena V. Mironova, MD, PhD (Medicine), cardiologist, head of the Department of cardiology, Central Clinical Hospital “RZhD-Medicine”. Address: 125367, Moscow, 84 Volokolamskoe Highway.
E-mail: e.v.mironova@mail.ru
ORCID: https://orcid.org/0000-0002-2988-1767
Tatiana V. Filippova, MD, assistant, senior laboratory assistant at the Department of therapy and polymorbid pathology named after academician M.S. Vovsi, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 125993, Moscow, 2/1 build.1 Barrikadnaya St.
E-mail: atv-tess@mail.ru
ORCID: https://orcid.org/0009-0004-7241-0938
Olga D. Ostroumova, MD, Dr. Sci. (Medicine), professor, head of the Department of therapy and polymorbid pathology named after academician M.S. Vovsi, Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia, professor of the Department of clinical pharmacology and propaedeutics of internal diseases, I.M. Sechenov First Moscow Medical University of the Ministry of Healthcare of Russia (Sechenov University). Address: 125993, Moscow, 2/1, build. 1 Barrikadnaya St.
E-mail: ostroumova.olga@mail.ru
ORCID: https://orcid.org/0000-0002-0795-8225. eLibrary SPIN: 3910-6585


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