Anti-ischaemic efficacy and tolerability of trimetazidine in elderly patients with angina pectoris - A sub-study from TRIMPOL-1 (trimetazidine in Poland)

Objective: Conventional anti-anginal agents may be associated with significant adverse effects in the elderly, often a direct consequence of their haemodynamic action. Trimetazidine is a metabolic agent, which acts at the myocardial mitochondrial level to exert an anti-ischaemic effect in the absence of significant haemodynamic changes. It may therefore be a particularly useful drug in the elderly. The aim of this open, multicentre study was to assess the anti-ischaemic efficacy and tolerability of trimetazidine when added to existing anti-anginal therapy in elderly patients with angina pectoris. Patients and Methods: 71 elderly patients (aged >65 years) with proven coronary artery disease and stable effort-induced angina were included. After a 1-week run-in period to ensure stability, open-label trimetazidine 20mg three times daily was administered for 4 weeks in combination with previous treatment (monotherapy with either a long-acting nitrate, beta-blocker or calcium antagonist). Results: Compared with baseline, trimetazidine significantly improved exercise duration (396.5 vs 362.6 sec; p < 0.01), time to onset of anginal pain (365.4 vs 239.3 sec; p < 0.01), time to 1mm ST-segment depression (300.9 vs 250.0 sec; p < 0.01) and total work (7.49 vs 7.12 metabolic equivalents; p = 0.014) during maximal exercise testing. Maximal ST-segment depression was attenuated compared with baseline. No changes in rate-pressure product were evident at maximal exercise. Other findings included a significant reduction in the frequency of anginal episodes and weekly nitrate consumption (both p < 0.01). Conclusions: These results indicate that trimetazidine is effective and well tolerated when used in combination with existing anti-anginal therapy in elderly patients with angina pectoris.