The influence of trimetazidine on the treatment of COPD associated with ischemic coronary artery disease

Abstract

Introduction: COPD associated with ischemic cardiopathy is not only a medical problem, but also a socio-economical one; its treatment still remains a current direction in contemporary medicine. The frequency of associated pathology is increasing and tends to affect younger people, of working age. Aim: To study the clinical efficacy of myocardial cytoprotector - trimetazidine (Preductal MB, France) and its use in the complex treatment of patients with COPD associated with ischemic cardiopathy. Objectives: 1. To study the influence of trimetazidine on clinical and paraclinical evolution of patients with COPD associated with ischemic cardiopathy. 2. Estimate the tolerance degree of trimetazidine in patients with COPD associated with ischemic cardiopathy. Material and methods: The study included 52 patients with II degree COPD, associated with ischemic cardiopathy (mean age 58,2±2,2 years) wich were divided into 2 similar groups. The basic group (n=26) received basic therapy combined with trimetazidine (70 mg/day), the control group (n=26) - only basic therapy. Diagnosis of COPD was set based on the GOLD criteria (2006) and the diagnosis of ischemic cardiopathy on the criteria developed by the Romanian Society of Cardiology (2004). The patients were investigated by ECG, Hollter, echocardiography, spirography, POL indexes: malonic dialdehyde (MDA), superoxide dismutase (SOD) and catalase. Results: Following the administration of combined therapy with trimetazidine it was found a significant decrease in the frequency of ischemic episodes by 33,6% (p <0,05) and in the frequency of dysrhythmias by 30,7% (p<0,05), while in the control group positive evolution was not statistically significant. It was determined a significant reduction of MDA by 1,85 (p<0,05), with the increase in SOD activity by 2,6 (p<0,05) and catalase by 1,5 (p<0,05), in the control group also being determined a positive, but insignificant, increase. It was determined the improvement of myocardial contractibility, the ejection fraction increasing by 11,8% (p<0.05), while in the control group the increase was insignificant. Respiratory function indexes in both groups improved, but there were no significant differences (p>0,l). During the study, the drug showed a good tolerance. Conclusion: Trimetazidine has a pronounced anti-ischemic, antiarrhythmic and antihypoxanth effect. The obtained results allow us to recommend the combined therapy with trimetazidine in the treatment of patients with COPD associated with ischemic cardiopathy.