Metabolic therapy in cardiology from the perspective of evidence-based medicine

Over the past few decades, various applications of the metabolic drugs have been extensively tested. Most of them affect oxygen-dependent processes, improving cellular metabolism and increasing tissue resistance to hypoxia and ischemia. The most promising candidates include components of the respira...

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Main Authors: V. I. Kostin, O. A. Shangina, V. G. Shelikhov
Format: Article
Language:Russian
Published: Kemerovo State Medical University 2021-03-01
Series:Фундаментальная и клиническая медицина
Subjects:
Online Access:https://fcm.kemsmu.ru/jour/article/view/374
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author V. I. Kostin
O. A. Shangina
V. G. Shelikhov
author_facet V. I. Kostin
O. A. Shangina
V. G. Shelikhov
author_sort V. I. Kostin
collection DOAJ
description Over the past few decades, various applications of the metabolic drugs have been extensively tested. Most of them affect oxygen-dependent processes, improving cellular metabolism and increasing tissue resistance to hypoxia and ischemia. The most promising candidates include components of the respiratory chain, purine nucleosides, and creatine phosphate which affect glucose oxidation and fatty acid metabolism in the Krebs cycle. This review critically evaluates the most popular drugs of this group (adenosine triphosphate, adenosine-5-monophosphate, creatine phosphate, coenzyme Q10, cytochrome C, adenosine, glucose-insulin-potassium solution, L-carnitine, mildronate, and trimetazidine), which are widely represented on the pharmaceutical market. Of all metabolic drugs, only trimetazidine was included in the European and Russian recommendations for the second-line treatment of stable angina. In most clinical studies, the therapeutic efficacy of metabolic drugs has been evaluated using the surrogate endpoints. Despite being actively advertised and widely used in the clinical practice, metabolic drugs currently do not have a convincing evidence base for affecting prognosis (mortality and/or major adverse cardiovascular events). Further studies in large-scale randomised trials are needed to confirm the beneficial effects of the metabolic drugs in cardiovascular medicine.
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spelling doaj-art-d2d03c01edf84596825f6c1adb70b01c2025-08-20T02:49:12ZrusKemerovo State Medical UniversityФундаментальная и клиническая медицина2500-07642542-09412021-03-0161606810.23946/2500-0764-2021-6-1-60-68252Metabolic therapy in cardiology from the perspective of evidence-based medicineV. I. Kostin0O. A. Shangina1V. G. Shelikhov2Kemerovo State Medical University, Kemerovo, Russian FederationKemerovo State Medical University, Kemerovo, Russian FederationKemerovo State Medical University, Kemerovo, Russian FederationOver the past few decades, various applications of the metabolic drugs have been extensively tested. Most of them affect oxygen-dependent processes, improving cellular metabolism and increasing tissue resistance to hypoxia and ischemia. The most promising candidates include components of the respiratory chain, purine nucleosides, and creatine phosphate which affect glucose oxidation and fatty acid metabolism in the Krebs cycle. This review critically evaluates the most popular drugs of this group (adenosine triphosphate, adenosine-5-monophosphate, creatine phosphate, coenzyme Q10, cytochrome C, adenosine, glucose-insulin-potassium solution, L-carnitine, mildronate, and trimetazidine), which are widely represented on the pharmaceutical market. Of all metabolic drugs, only trimetazidine was included in the European and Russian recommendations for the second-line treatment of stable angina. In most clinical studies, the therapeutic efficacy of metabolic drugs has been evaluated using the surrogate endpoints. Despite being actively advertised and widely used in the clinical practice, metabolic drugs currently do not have a convincing evidence base for affecting prognosis (mortality and/or major adverse cardiovascular events). Further studies in large-scale randomised trials are needed to confirm the beneficial effects of the metabolic drugs in cardiovascular medicine.https://fcm.kemsmu.ru/jour/article/view/374metabolic therapycardiologyanginaclinical studiesefficacy
spellingShingle V. I. Kostin
O. A. Shangina
V. G. Shelikhov
Metabolic therapy in cardiology from the perspective of evidence-based medicine
Фундаментальная и клиническая медицина
metabolic therapy
cardiology
angina
clinical studies
efficacy
title Metabolic therapy in cardiology from the perspective of evidence-based medicine
title_full Metabolic therapy in cardiology from the perspective of evidence-based medicine
title_fullStr Metabolic therapy in cardiology from the perspective of evidence-based medicine
title_full_unstemmed Metabolic therapy in cardiology from the perspective of evidence-based medicine
title_short Metabolic therapy in cardiology from the perspective of evidence-based medicine
title_sort metabolic therapy in cardiology from the perspective of evidence based medicine
topic metabolic therapy
cardiology
angina
clinical studies
efficacy
url https://fcm.kemsmu.ru/jour/article/view/374
work_keys_str_mv AT vikostin metabolictherapyincardiologyfromtheperspectiveofevidencebasedmedicine
AT oashangina metabolictherapyincardiologyfromtheperspectiveofevidencebasedmedicine
AT vgshelikhov metabolictherapyincardiologyfromtheperspectiveofevidencebasedmedicine