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Review
. 2025 Jul;25(4):443-460.
doi: 10.1007/s40256-025-00724-1. Epub 2025 Apr 3.

Trimetazidine in Cardiovascular Disease and Beyond: A Comprehensive Review

Harsh Goel  1   2 , Nicholas Roma  3 , Michael Morgan  3 , Riya Arora  4 , Nayanika Sreejith  5 , Deepak Goyal  6 , Sunil Nadar  7
Affiliations
Review

Trimetazidine in Cardiovascular Disease and Beyond: A Comprehensive Review

Harsh Goel et al. Am J Cardiovasc Drugs. 2025 Jul.

Abstract

Trimetazidine is a metabolic modulator that acts as a competitive inhibitor of the terminal enzyme in the β-oxidation pathway to shift energy substrate from free fatty acids to the more oxygen-efficient glucose metabolism. The resulting conservation of cellular adenosine triphosphate generation in the face of ischemia/hypoxia mediates the anti-ischemic efficacy of trimetazidine. Clinically, trimetazidine has been approved as an add-on treatment in patients with symptomatic angina that is poorly controlled with first-line agents or who cannot tolerate the first-line therapy. In addition, trimetazidine has demonstrated antioxidant, cytoprotective, and anti-apoptotic activity with applications beyond angina. The aim of this review was to summarize the mechanism of action and anti-anginal efficacy of trimetazidine and to discuss the putative role of these pleiotropic effects and the evidence behind its application in cardiovascular diseases in general.

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Conflict of interest statement

Declarations. Funding: No external funding was used in the preparation of this manuscript Conflicts of interest: Harsh Goel, MD; Nicholas Roma, MD; Michael Morgan, MD; Riya Arora; Nayanika Sreejith; Deepak Goyal; and Sunil Nadar, MD, have no potential conflicts of interest that might be relevant to the contents of this manuscript Author contributions: Harsh Goel, Deepak Goyal, Sunil Nadar: conceptualization, writing, and reviewing. Michael Morgan, Nicholas Roma, Nayanika Sreejith, Riya Arora: literature search, collating/organizing literature search, organizing data in tables, reviewing, and editing. Data availability statement: Data sharing is not applicable to this article as no datasets were generated for this manuscript. Ethics approval: Not applicable. Code availability: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable.

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