Медикаментозное лечение стабильной стенокардии: место триметазидина
https://doi.org/10.38109/2225-1685-2022-4-82-89
Аннотация
По данным международных эпидемиологических исследований, общее число зарегистрированных случаев сердечно-сосудистых заболеваний (ССЗ), с 1990 г. по 2019 г. возросло практически в два раза, достигнув 523 миллионов, а количество смертей от ССЗ в 2019 году увеличилось более, чем в полтора раза (18,6 миллионов). Основной вклад в это вносят ишемическая болезнь сердца (ИБС) и инсульт. В 2019 г. зарегистрировано 197 миллионов случаев ИБС, а количество смертей, вызванных ею, превысило половину всех случаев сердечно-сосудистой смертности (9,14 миллионов). Пациенты со стабильной стенокардией составляют большую часть больных с ИБС. Несмотря на существующие современные методы лечения пациенты с хронической ИБС продолжают страдать от ангинальных болей, что значительно снижает их толерантность к физическим нагрузкам и ухудшает качество жизни. В клинической практике, как показывают исследования, тяжесть и частота стенокардии у пациентов остаются недооцененными врачами, соответственно своевременно не корректируется медикаментозная терапия, не используются в полном объёме возможности комбинированной антиангинальной терапии. Триметазидин как антиангинальный препарат, действующий на метаболизм ишемизированной миокардиальной клетки (влияние на ишемический каскад путём уменьшения клеточного ацидоза и увеличения содержания АТФ), доказал свою эффективность и безопасность при лечении стенокардии независимо от механизма, вызвавшего ишемию при монотерапии и в комбинации, прежде всего с бета-адреноблокаторами (БАБ).
Ключевые слова
При поддержке: Публикация подготовлена при информационной и финансовой поддержке фармацевтической компании Сервье, что не повлияло на мнение автора.
Об авторе
Е. А. Темникова
ГБОУ ВПО ОмГМУ Минздрава России
Россия
Россия
Темникова Елена Андреевна, д.м.н., доцент, профессор кафедры поликлинической терапии и внутренних болезней
ул. Ленина, д. 12, г. Омск 644099
Список литературы
1. Roth G.A., Mensah G.A., Johnson C.O., et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019. J Am Coll Cardiol. 2020; Dec 22; 76(25):2982–3021. https://doi.org/10.1016/j.jacc.2020.11.010
2. Hemingway H., McCallum A., Shipley M., et al. Incidence and prognostic implications of stable angina pectoris among women and men. JAMA. 2006; Mar 22;295(12):1404-11. https://doi.org/10.1001/jama.295.12.1404
3. Javitz H.S., Ward M.M., Watson J.B., Jaana M. Cost of illness of chronic angina. Am J Manag Care. 2004 Oct;10(11):S358-69.
4. Knuuti J., Wijns W., Saraste A., et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal, 14 January 2020; 41(3):407–477. https://doi.org/10.1093/eurheartj/ehz425
5. Blumenthal D. M., Howard S. E., Como J. S., et al. Prevalence of Angina Among Primary Care Patients With Coronary Artery Disease. JAMA Netw Open. 2021 Jun 1;4(6):e2112800. https://doi.org/10.1001/jamanetworkopen.2021.12800
6. Manolis A. J., Ambrosio G., Collins P. et al. Impact of stable angina on health status and quality of life perception of currently treated patients. The BRIDGE 2 survey. Eur J Intern Med. 2019 Dec; 70:60-67. https://doi.org/10.1016/j.ejim.2019.09.013
7. Shafiq A., Arnold S. V., Gosch K., et al. Patient and physician discordance in reporting symptoms of angina among stable coronary artery disease patients: Insights from the Angina Prevalence and Provider Evaluation of Angina Relief (APPEAR) study. Am Heart J. 2016 May;175:94-100. https://doi.org/10.1016/j.ahj.2016.02.015
8. Mesnier J., Ducrocq G., Danchin N., et al. International Observational Analysis of Evolution and Outcomes of Chronic Stable Angina: The Multinational CLARIFY Study. Circulation. 2021 Aug 17;144(7):512-523. https://doi.org/10.1161/CIRCULATIONAHA.121.054567
9. Foley M., Rajkumar C., A., Shun-Shin M., et al. Achieving Optimal Medical Therapy: Insights From the ORBITA Trial. J Am Heart Assoc. 2021. Feb 2;10(3):e017381. https://doi.org/10.1161/JAHA.120.017381
10. Benjamin E. J., Blaha M. J., Chiuve S. E., et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017. Mar 7;135(10):e6032017. https://doi.org/10.1161/CIR.0000000000000485
11. Beltrame J. F., Weekes A. J., Morgan C., et al. The prevalence of weekly angina among patients with chronic stable angina in primary care practices: The Coronary Artery Disease in General Practice (CADENCE) Study. Arch Intern Med. 2009 Sep 14;169(16):1491-9. https://doi.org/10.1001/archinternmed.2009.295
12. Peric V. M., Borzanovic M. D., Stolic R. V., et al. Severity of angina as a predictor of quality of life changes six months after coronary artery bypass surgery. Ann Thorac Surg. 2006 Jun;81(6):2115-20. https://doi.org/10.1016/j.athoracsur.2006.01.033
13. Camm A. J., Manolis A., Ambrosiont G., et al. Unresolved issues inthe management of chronic stable angina. Int J Cardiol. 2015 Dec 15;201:200-7. https://doi.org/10.1016/j.ijcard.2015.08.045
14. Rieckmann N., Neumann K., Feger S., et al. Health-related qualify oflife, angina type and coronary artery disease in patients with stable chest pain. Health Qual Life Outcomes. 2020. May 14;18(1):140. https://doi.org/10.1186/s12955-020-01312-4
15. Ambrosio G., , Collins P., Dechend R., et al. Sta Ble Angina: Pe Rcept Ion of Nee Ds, Quality of Life and Mana Gem Ent of Patients (BRIDGE Study)-A Multinational European Physician Survey. Angiology. 2019 May;70(5):397-406. https://doi.org/10.1177/0003319718796
16. Qintar M.,Spertus J. A., Kensey L Gosch K., L., et al. Effect of angina under-recognition on treatment in outpatients with stable ischaemic heart disease. Eur Heart J Qual Care Clin Outcomes. 2016;2(3):208-214. https://doi.org/10.1093/ehjqcco/qcw016
17. Fihn S. D., Blankenship D. C., Alexander K. P., et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of ThoracicSurgeons. J Thorac Cardiovasc Surg. 2015 Mar;149(3):e5-23. https://doi.org/10.1016/j.jtcvs.2014.11.002
18. Стабильная ишемическая болезнь сердца. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(11):4076. https://doi.org/10.15829/1560-4071-2020-4076
19. Marzilli M., Merz C. N. B., Boden W.E., et al. Obstructive coronary atherosclerosis and ischemic heart disease: an elusive link! Am Coll Cardiol. 2012 Sep 11;60(11):951-6. https://doi.org/10.1016/j.jacc.2012.02.082
20. Thadani U. Management of Stable Angina - Current Guidelines: A Critical Appraisal. Cardiovasc Drugs Ther. 2016 Aug;30(4):419-426. https://doi.org/10.1007/s10557-016-6681-2
21. Ambrosio G., Mugelli A., Lopez-Sendon J., et al. Management of stable angina: A commentary on the European Society of Cardiology guidelines. Eur J Prev Cardiol. 2016 Sep;23(13):1401-12. https://doi.org/10.1177/2047487316648475
22. Manolis, A. J., Poulimenos l. E., Ambrosio G., et al. Medical treatment of stable angina: a tailored therapeutic approach. Int. J. Cardiol. 2016 Oct 1;220:445-53. https://doi.org/10.1016/j.ijcard.2016.06.150
23. Steg P. G., Greenlaw N., Tendera M., et al. Prevalence of anginal symptoms and myocardial ischemia and their effect on clinical outcomes in outpatients with stable coronary artery disease: data from the International Observational CLARIFY Registry. JAMA Intern Med. 2014. Oct;174(10):1651-9. https://doi.org/10.1001/jamainternmed.2014.3773
24. Kureshi F, Ali Shafiq A., Arnold S. V., et al. The prevalence and management of angina among patients with chronic coronary artery disease across US outpatient cardiology practices: insights from the Angina Prevalence and Provider Evaluation of Angina Relief (APPEAR) study. Clin Cardiol. 2017 Jan;40(1):6-10. https://doi.org/10.1002/clc.22628
25. Ferrari R, Camici P. G., Crea F., et al. Expert consensus document: A ‘diamond’ approach to personalized treatment of angina. Nat Rev Cardiol. 2018. Feb;15(2):120-132. https://doi.org/10.1038/nrcardio.2017.131
26. Kantor P. F., Lucien A., Kozak R., Lopaschuk G. D. The antianginal drug trimetazidine shifts cardiac energy metabolism from fatty acid oxidation to glucose oxidation by inhibiting mitochondrial long-chain 3-ketoacyl coenzyme A thiolase. Circ Res. 2000. Mar 17;86(5):580-8. https://doi.org/10.1161/01.RES.86.5.580
27. Fragasso G., Perseghin G., De Cobelli F., et al. Effects of metabolic modulation by trimetazidine on left ventricular function and phosphocreatine/adenosine triphosphate ratio in patients with heart failure. Eur Heart J. 2006. Apr;27(8):942-8. https://doi.org/10.1093/eurheartj/ehi816
28. Danchin N., Marzilli M., Parkhomenko A., Ribeiro J. P. Efficacy comparison of trimetazidine with therapeutic alternatives in stable angina pectoris: a network meta-analysis. Cardiology. 2011;120(2):59–72. https://doi.org/10.1159/000332369
29. Dalla-Volta S., Maraglino G., Della-Valentina P., et al. Comparison of trimetazidine with nifedipine in effort angina: a double-blind,crossover study. Cardiovasc Drugs Ther. 1990;4(4):853–859. https://doi.org/10.1007/BF00051292
30. Szwed H., Sadowski Z., Elikowski W., et al. Combination treatment in stable effort angina using trimetazidine and metoprolol. Results of a randomized, double-blind, multicentre study (TRIMPOL II) Eur Heart J. 2001 Dec;22(24):2267-74. https://doi.org/10.1053/euhj.2001.2896
31. Detry J. M., Sellier P., Pennaforte S., et al. Trimetazidine: a new concept in the treatment of angina. Comparison with propranolol in patients with stable angina. Trimetazidine European Multicenter Study Group. Br J Clin Pharmacol. 1994 Mar;37(3):279-88. https://doi.org/10.1111/j.1365-2125.1994.tb04276.
32. Pornin M., Harpey C., Allal J., et al. Lack of effects of trimetazidine on systemic hemodynamics in patients with coronary artery disease: a placebocontrolled study. Clin Trials Metaanal. 1994 Apr;29(1):49-56.
33. 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 Dec 20;177(3):780-5. https://doi.org/10.1016/j.ijcard.2014.10.149
34. 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. Clini Drug Invest. 1997;13(1): 8–14. https://doi.org/10.2165/00044011-199713010-00002
35. Szwed H., Sadowski Z., Pachocki R., et al. Proposed antiischemic effects of trimetazidine in coronary diabetic patients. A substudy from TRIMPOL-1. Cardiovasc Drugs Ther 1999; 13:217-222. https://doi.org/10.1023/A:1007744109064
36. Gao D., Ning N., Niu X., et al. Trimetazidine: a metaanalysis of randomised controlled trials in heart failure. Heart. 2011. Feb;97(4):278-86. http://dx.doi.org/10.1136/hrt.2010.208751
37. Zhang L., Lu Y., Jiang H., et al. Additional use of trimetazidine in patients with chronic heart failure: a meta-analysis. J Am Coll Cardiol. 2012. Mar 6;59(10):913-22. https://doi.org/10.1016/j.jacc.2011.11.027
38. Mahajan S., Mahajan A. U. Current Clinical Evidence of Trimetazidine in the Management of Heart Disease in Patients with Diabetes. J Assoc Physicians India 2020 Nov;68(11):46-50.
39. Al-Lamee R., Thompson D., Dehbi H-M., et al. Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial. Lancet. 2018;391(10115):31–40. https://doi.org/10.1016/S0140-6736(17)32714-9
40. Ferrari R., Ford I., Greenlaw N., et al. Geographical variations in the prevalence and management of cardiovascular risk factors in outpatients with CAD: data from the contemporary CLARIFY registry. Eur J Prev Cardiol. 2015;22(8):1056–1065. https://doi.org/10.1177/2047487314547652
41. Steg P. G., Ferrari R., Ford I., et al. Heart rate and use of beta-blockers in stable outpatients with coronary artery disease. PLoS ONE. 2012;7(5):e36284. https://doi.org/10.1371/journal.pone.0036284
42. Glezer M. Trimetazidine and Bisoprolol to Treat Angina in Symptomatic Patients: Post Hoc Analysis From the CHOICE-2 Study. Cardiol Ther. 2021 Jun;10(1):161-173. https://doi.org/10.1007/s40119-020-00202-6
43. Glezer M. Real-world Evidence for the Antianginal Efficacy of Trimetazidine from the Russian Observational CHOICE-2 Study. Adv Ther. 2017. Apr;34(4):915-924. https://doi.org/10.1007/s12325-017-0490-2
44. Tendera M., Fox K., Ferrari R., et al. Inadequate heart rate control despite widespread use of beta-blockers in outpatients with stable CAD: findings from the international prospective CLARIFY registry.Int J Cardiol. 2014;176(1):119–124. https://doi.org/10.1016/j.ijcard.2014.06.052
45. Boyle R. M., Bray C. L., Naqvi N., et al. A comparison of once and twice daily atenolol for angina pectoris. Int J Cardiol. 1983;3(1):25–35. https://doi.org/10.1016/0167-5273(83)90058-X
46. Gislason G. H., Rasmussen J. N., Abildstrom S. Z., et al. Long-term compliance with beta-blockers, angiotensin-converting enzyme inhibitors, and statins after acute myocardial infarction. Eur Heart J. 2006. May;27(10):1153-8. https://doi.org/10.1093/eurheartj/ehi705
47. Glezer M., Vygodin V. A. Anti-Anginal Effectiveness and Tolerability of Trimetazidine Modified Release 80Mg Once Daily in Stable Angina Patients in Real-World Practice. Adv Ther. 2018. Sep;35(9):1368-1377. https://doi.org/10.1007/s12325-018-0756-3
48. Glezer M. G., Vygodin V. A. Effectivnes of Trimetazidine in Patients with Stable Angina Pectoris of Various Duration: Results from ODA. Cardiol Ther. 2020. Dec;9(2):395-408. https://doi.org/10.1007/s40119-020-00174-7
49. Глезер М. Г., Выгодин В. А. Оценка антиангинальной эффективности триметазидинав новой лекарственной форме для однократного приема в зависимости от региона Российской Федерациию Анализ 3 066 пациентов с ИБС, включенных в исследование ОДА. Кардиология. 2019;59(10S):52-63. https://doi.org/10.18087/cardio.n541
50. Lopatin Y., Petrova P., Effectiveness and Tolerability of Trimetazidine 80 Mg Once Daily in Patients with Stable Angina Uncontrolled with Bisoprolol-Based Therapy: The Modus Vivendi Observational Study. Cardiol Ther. 2022. Mar;11(1):93-111. https://doi.org/10.1007/s40119-021-00249-z
51. Ferrari R., Ford J., Fox K., et al. A randomized, double-blind, placebo-controlled trial to assess the efficAcy and safety of Trimetazidine in patients with angina pectoris having been treated by percutaneous coronary intervention (ATPCI study): Rationale, design, and baseline characteristics. Am Heart J. 2019. https://doi.org/10.1016/j.ahj.2018.12.015
52. János Tomcsányi J. Comparison of the efficacy of trimetazidine in revascularized and non-revascularized stable angina patients based on the ONECAPS study. Orv Hetil. 2021. Jul 18;162(29):1167-1171. https://doi.org/10.1556/650.2021.32138
53. Tomcsányi j., Szakács L. Effectiveness of trimetazidine prolong in stable coronary artery disease. Multicenter, prospective, observational study, ONECAPS study. Orv Hetil. 2018. Sep;159(38):1549-1555. https://doi.org/10.1556/650.2018.31251
54. Patrono C., Galiuto L. Weak hypothesis? Wrong pharmacological tool? Inadequate experimental design? Comment on the ATPCI trial. Eur Heart J. 2020. Nov 14;41(43):4166-4167. https://doi.org/10.1093/eurheartj/ehaa865
55. Dalal J., Kapoor A. ACPTI study: Being positive in a negative situation is not naivety – Trimetazidine still has role in symptomatic CAD patients. Indian Heart J. 2021. Jan-Feb;73(1):135-137. https://doi.org/10.1016/j.ihj.2020.12.013
56. Nair T., Joshi S. R. Do we need to change the Patient Indications for Trimetazidine after ATPCI? J Assoc Physicians India. 2021. Apr;69(4):11-12.
57. Boden W. E., O’Rourke R. A., Teo K. K., et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007 .Apr 12;356(15):1503-16. https://doi.org/10.1056/NEJMoa070829
58. Weisz G., Genereux P., Iniguez A., et al. Ranolazine in patients with incomplete revascularisation after percutaneous coronary intervention (RIVER-PCI): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2016. Jan 9;387(10014):136-45. https://doi.org/10.1016/S0140-6736(15)00459-6
59. Maron D. J., Spertus J. A., Mancini G. B., et al. Impact of an initial strategy of medical therapy without percutaneous coronary intervention in high-risk patients from the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial. Am J Cardiol. 2009. Oct 15;104(8):1055-62. https://doi.org/10.1016/j.amjcard.2009.05.056
60. Jamshed Dalal, Aditya Kapoor ACPTI study: Being positive in a negative situation is not naivety – Trimetazidine still has role in symptomatic CAD patients Indian Heart J. 2021 Jan-Feb;73(1):135-137. https://doi.org/10.1016/j.ihj.2020.12.013
Рецензия
Для цитирования:
Темникова Е.А. Медикаментозное лечение стабильной стенокардии: место триметазидина. Евразийский Кардиологический Журнал. 2022;(4):82-89. https://doi.org/10.38109/2225-1685-2022-4-82-89
For citation:
Temnikova E.A. Pharmacological treatment of stable angina pectoris: the place of trimetazidine. Eurasian heart journal. 2022;(4):82-89. (In Russ.) https://doi.org/10.38109/2225-1685-2022-4-82-89
Просмотров:
355
Послать статью по эл. почте 
