Effects of Trimetazidine Treatment on the Lipoprotein-Associated Phospholipase A2 Level and Exercise Parameters in Patients with Stable Angina Pectoris

Giriş: Kararlı anjina pektorisli hastalarda, metabolik bir anti-iskemik ilaç olan trimetazidin (TMZ) tedavisinin risk faktörü olarak kabul edilen lipoprotein ilişkili fosfolipaz A2(Lp-PLA2 ) düzeyi ve egzersiz parametreleri üzerine etkisi araştırıldı. Hastalar ve Yöntem: Egzersiz testi pozitif olan kararlı anjina pektorisli 30 hasta (ort. yaş 62.1 ± 8.3; dağılım 47-77) çalışmaya alındı. Trimetazidin tedavisi öncesinde Lp-PLA2düzeyleri ölçüldü; 12 haftalık TMZ tedavisi sonrasında egzersiz testi ve Lp-PLA2ölçümleri tekrarlandı. Bulgular: Trimetazidin tedavisi sonrasında Lp-PLA2düzeyleri anlamlı düşüş (p= 0.006), egzersiz iş yükü anlamlı artış (p= 0.048) gösterdi. Sonuç: Trimetazidin tedavisi kardiyak metabolizma değişikliği sonucu serbest oksijen radikal oluşumunu ve enfl amasyonu azaltarak Lp-PLA2düzeyinde anlamlı düşüş sağlamaktadır. Bu bulgu, egzersiz parametrelerindeki iyileşmelerle birlikte, TMZ tedavisinin kararlı anjina pektorisli hastaların prognozunda olumlu katkı sağlayabileceğini göstermektedir.

Kararlı Anjina Pektorisli Hastalarda Trimetazidin Tedavisinin Lipoprotein İlişkili Fosfolipaz A2 Düzeyi ve Egzersiz Parametreleri Üzerine Etkisi

Introduction: We examined the clinical effectiveness of trimetazidine (TMZ), a metabolic anti-ischemic agent, on lipoprotein-associated phospholipase A2(Lp-PLA2 ) levels, which is considered a risk factor for cardiovascular events, and on exercise parameters in patients with stable angina pectoris (SAP). Patients and Methods: The study included 30 patients (mean age 62.1 ± 8.3 years; range 47 to 77 years) with SAP and a positive exercise test result. Serum Lp-PLA2levels were measured at baseline. Exercise testing and Lp-PLA2measurements were repeated after at least 12 weeks of TMZ treatment. Results: After TMZ treatment, Lp-PLA2levels decreased signifi cantly (p= 0.006), and workload increased signifi cantly (p= 0.048). Conclusion: Trimetazidine treatment reduces serum Lp-PLA2levels via shifting cardiac metabolism, resulting in decreased production of free oxygen radicals and infl ammation. This fi nding, together with improvements in exercise test parameters, suggests that TMZ may have a benefi cial effect on the prognosis of patients with SAP

___

  • Hu B, Li W, Xu T, Chen T, Guo J. Evaluation of trimetazidine in angina pectoris by echocardiography and radionuclide angiography: a meta- analysis of randomized, controlled trials. Clin Cardiol 2011;34:395-400.
  • Epps KC, Wilensky RL. Lp-PLA2-a novel risk factor for high-risk coronary and carotid artery disease. J Intern Med 2011;269:94-106.
  • Colley KJ, Wolfert RL, Cobble ME. Lipoprotein associated phospholipase A(2): role in atherosclerosis and utility as a biomarker for cardiovascular risk. EPMA J 2011;2:27-38.
  • Zalewski A, Macphee C. Role of lipoprotein-associated phospholipase A2 in atherosclerosis: biology, epidemiology, and possible therapeutic target. Arterioscler Thromb Vasc Biol 2005;25:923-31.
  • Siama K, Tousoulis D, Papageorgiou N, Siasos G, Tsiamis E, Bakogiannis C, et al. Stable angina pectoris: current medical treatment. Curr Pharm Des 2013;19:1569-80.
  • Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F, et al. Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. Eur Heart J 2006;27:1341-81.
  • Bertomeu-Gonzalez V, Bouzas-Mosquera A, Kaski JC. Role of trimetazidine in management of ischemic cardiomyopathy. Am J Cardiol 2006;98(5A):19J-24J.
  • Maridonneau-Parini I, Harpey C. Effect of trimetazidine on membrane damage induced by oxygen free radicals in human red cells. Br J Clin Pharmacol 1985;20:148-51.
  • Park KH, Park WJ, Kim MK, Park DW, Park JH, Kim HS, et al. Effects of trimetazidine on endothelial dysfunction after sheath injury of radial artery. Am J Cardiol 2010;105:1723-7.
  • Zhou X, Li C, Xu W, Chen J. Trimetazidine protects against smoking- induced left ventricular remodeling via attenuating oxidative stress, apoptosis, and infl ammation. PLoS One 2012;7:e40424.
  • Kuralay F, Altekin E, Yazlar AS, Onvural B, Goldeli O. Suppression of angioplasty-related infl ammation by pre-procedural treatment with trimetazidine. Tohoku J Exp Med 2006;208:203-12.
  • Packard CJ, O'Reilly DS, Caslake MJ, McMahon AD, Ford I, Cooney J, et al. Lipoprotein-associated phospholipase A2 as an independent predictor of coronary heart disease. West of Scotland Coronary Prevention Study Group. N Engl J Med 2000;343:1148-55.
  • Corson MA, Jones PH, Davidson MH. Review of the evidence for the clinical utility of lipoprotein- associated phospholipase A2 as a cardiovascular risk marker. Am J Cardiol 2008;101:41F-50F.
  • Koenig W, Twardella D, Brenner H, Rothenbacher D. Lipoprotein- associated phospholipase A2 predicts future cardiovascular events in patients with coronary heart disease independently of traditional risk factors, markers of infl ammation, renal function, and hemodynamic stress. Arterioscler Thromb Vasc Biol 2006;26:1586-93.
  • Gerber Y, McConnell JP, Jaffe AS, Weston SA, Killian JM, Roger VL. Lipoprotein-associated phospholipase A2 and prognosis after myocardial infarction in the community. Arterioscler Thromb Vasc Biol 2006;26:2517-22.
  • Sabatine MS, Morrow DA, O'Donoghue M, Jablonksi KA, Rice MM, Solomon S, et al. Prognostic utility of lipoprotein-associated phospholipase A2 for cardiovascular outcomes in patients with stable coronary artery disease. Arterioscler Thromb Vasc Biol 2007;27:2463-9.
  • Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) fi nal report. Circulation 2002;106:3143-421.
  • Güler N, Eryonucu B, Güneş A, Güntekin U, Tuncer M, Özbek H. Effects of trimetazidine on submaximal exercise test in patients with acute myocardial infarction. Cardiovasc Drugs Ther 2003;17:371-4.
  • Koylan N, Bilge AK, Adalet K, Mercanoğlu F, Büyüköztürk K, TTS Group. Comparison of the effects of trimetazidine and diltiazem on exercise performance in patients with coronary heart disease. The Turkish trimetazidine study (TTS). Acta Cardiol 2004;59:644-50.
Koşuyolu Heart Journal-Cover
  • ISSN: 2149-2972
  • Yayın Aralığı: Yılda 3 Sayı
  • Başlangıç: 1990
  • Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi
Sayıdaki Diğer Makaleler

Atriyum Fibrilasyonunun İlaç Tedavisindeki Yenilikler

Yusuf TÜRKMEN, Cengizhan TÜRKOĞLU, Mustafa YILDIZ

Koroner Arter Çıkış Anomalisinde Başarılı Perkütan Koroner Girişim

Hüseyin AYHAN, Hacı Ahmet KASAPKARA, Abdullah Nabi ASLAN, Tahir DURMAZ, Telat KELEŞ, Engin BOZKURT

Loküle Perikart Efüzyonunun Sağ Parasternal Perikardiyosentez ile Başarılı Tedavisi

Mustafa Adem TATLISU, Emrah BOZBEYOĞLU, Bülent AYDEMİR, Zekeriya NURKALEM

Kararlı Anjina Pektorisli Hastalarda Trimetazidin Tedavisinin Lipoprotein İlişkili Fosfolipaz A2 Düzeyi ve Egzersiz Parametreleri Üzerine Etkisi

Cem BOSTAN, Erdem KARACOP, Cüneyt KOÇAŞ, Okay ABACI, Ayşem KAYA, Zerrin YİĞİT

Stabil Koroner Arter Hastalığında Doğrudan Stentleme ve Ön-dilatasyon Sonrası Stentleme Yöntemlerinin TIMI Kare Sayısı Kullanılarak Karşılaştırılması

Mehmet EYÜBOĞLU, Bahri AKDENİZ, Ömer ŞENARSLAN, Mehmet Akif EKİNCİ, Abdurrahman ARSLAN, Fatih AYTEMİZ, İlhan KOYUNCU, Barış ÜNAL, Betül KOYUNCU

Mitral KapakYarığına Bağlı Ciddi Mitral Yetersizliği

Cenk SARI, Hüseyin BAYRAM, Serdal BAŞTUĞ

İnatçı Koroner Perforasyon Olgusunda İç İçe Kaplı Stent Kullanımı

Oğuz KARACA, Hacı Murat GÜNEŞ, Beytullah ÇAKAL, İrfan BARUTÇU, Muhsin TÜRKMEN

Koroner Baypas Cerrahisi ile Beraber Hiatus Hernisi Onarımı

Hasan REYHANOĞLU, Kaan ÖZCAN, Hidayet ÇATAL, Suna GÜZELDOĞAN, Ümit İlker TEKİN

Atipik Shone Kompleksi

Hüseyin AYHAN, Abdullah Nabi ASLAN, Hacı Ahmet KASAPKARA

Kliniğimize ST Yükselmeli Miyokart İnfarktüsü Nedeniyle Başvuran Hastalarda Tercih Edilen Tedavi Stratejilerinin Karşılaştırılması (Yaşam İçin Trombolitik Tedavi)

Mahmut ÖZDEMİR, Nesim ALADAĞ, Ferit Onur MUTLUER, Musa ŞAHİN