Current Clinical Evidence of Trimetazidine in the Management of Heart Disease in Patients with Diabetes.

Diabetes Mellitus (DM) is a global heath burden and the leading cause for cardiovascular (CV) disease. The differential presentation of CV disease in DM is related to the metabolic derangements leading to deterioration of myocardial cell function and its serious consequences. Therefore, there is a need for early and effective treatment intervention for this myocardial cell metabolic dysfunction. DM and myocardial ischemia (MI) share a common metabolic dysregulation mediated via increased fatty acid oxidation that makes the diabetic heart susceptible to myocardial ischemia and reduced myocardial performance during ischemia compared to non-diabetic heart. Modulation of myocardial free fatty acid metabolism should be the key target for metabolic interventions in patients with Diabetic CV complications. Trimetazidine, a fatty acid metabolic modulator, has shown to improve CV outcomes in diabetes. The present review summarizes the clinical evidence and relevance of trimetazidine as an anti-anginal and antiischemic agent in patients with DM. Evidence suggested that trimetazidine could significantly improve clinical outcomes in patients with angina or heart failure and diabetes. Administering trimetazidine in patients with diabetes undergoing re-vascularization could also provide significant clinical benefits. Current clinical practice guidelines also recommend trimetazidine as a first-line agent for selected patients or as a second-line treatment option for angina patients.