The Metabolic Treatment of Patients with Coronary Artery Disease: Effects on Quality of Life and Effort Angina

The effectiveness of drug therapy in controlling angina and the resulting improvement in exercise capacity were reviewed. We performed a Medline search of published reports on ranolazine, trimetazidine, and other medicines that act metabolically. Quality of life with regards to work capacity alone was analyzed. Most reports were about trimetazidine, with strong evidence of its efficacy and tolerability. Its effect on episodes of angina, total exercise time, and time to the onset of ischemia on ECG is impressive with no negative effects found on double product (workload) and improvement in quality of life. The second most evaluated drug was ranolazine, particularly regarding quality of life. Results are similar to those with trimetazidine but are not as significant for quality of life issues. For the other drugs, L-carnitine, ribose, and dichloroacetate, accumulated experimental data provide a physiological background in which clinical trials have been started, but as yet very few patients have been enrolled. Also, studies that intended to evaluate, by echocardiography, ischemic dysfunction induced by dobutamine-atropine stress were examined; these also showed a reduction in ischemia and fewer anginal episodes, but only with trimetazidine in this regard. Taken together, these drug effects are important to ameliorate quality of life. The issue of quality of life was evaluated in specific reports, and the results of the application of validated questionnaires (SF36, 5-dimensional EuroQol Instrument, and Seattle Angina Questionnaire) attest to the positive drug effects on patients' perception of wellness, particularly with the use of trimetazidine, and less with ranolazine.