Comparison of trimetazidine plus sildenafil to chronic nitrates in the control of myocardial ischemia during sexual activity in patients with coronary artery disease

• Published in: The American journal of cardiology Vol. 95; no. 3; pp. 327 - 331
• Main Authors: Rosano, Giuseppe M.C., Marazzi, Giuseppe, Patrizi, Roberto, Cerquetani, Elena, Vitale, Cristiana, Volterrani, Maurizio, Fini, Massimo, Mercuro, Giuseppe
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2005; Elsevier
• Subjects: Adult; Aged; Analysis of Variance; Biological and medical sciences; Cardiology. Vascular system; Coitus; Coronary heart disease; Cross-Over Studies; Double-Blind Method; Drug Therapy, Combination; Electrocardiography, Ambulatory; Erectile Dysfunction - drug therapy; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Ischemia - prevention & control; Myocarditis. Cardiomyopathies; Nitrates - therapeutic use; Phosphodiesterase Inhibitors - therapeutic use; Piperazines - therapeutic use; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome; Trimetazidine - therapeutic use; Vasodilator Agents - therapeutic use; Human; Cardiovascular disease; Myocardial ischemia; Nitrates; Myocardial disease; Coronary heart disease; Trimetazidine; Vascular disease; Chronic; Control; Sexuality; Sildenafil; Comparative study
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2004.09.028

A large proportion of patients who have erectile dysfunction also have coronary artery disease (CAD). In these patients, nitrate therapy is a contraindication to the use of sildenafil. To assess whether the metabolic anti-ischemic agent, trimetazidine, is effective in controlling episodes of myocardial ischemia during sexual activity in patients who have CAD and use long-term nitrate therapy, we studied 38 men (57 ± 6 years of age) who had proved CAD. Patients underwent 24-hour ambulatory electrocardiographic monitoring at baseline, after 1 week of oral nitrate therapy (20 mg 3 times a day), and after 1 week of trimetazidine (20 mg 3 times a day). Patients were asked to engage in ≥1 session of sexual intercourse during each session of ambulatory electrocardiographic monitoring. They were instructed to take sildenafil (100 mg) 1 hour before sexual intercourse performed at baseline and during therapy with trimetazidine and sildenafil or placebo (blinded) during therapy with nitrates. A decrease in total ischemic burden was observed with nitrates and trimetazidine compared with baseline (−3 ± 1.2 episodes/patient/24 hours vs −5 ± 1.3 episodes/patient/24 hours and −6 ± 5 min/patient/24 hours vs −8 ± 3 min/patient/24 hours, p <0.01 for nitrates and trimetazidine vs baseline). Trimetazidine plus sildenafil was more effective in controlling episodes of myocardial ischemia during sexual activity than nitrates alone (−45 ± 11% vs −18 ± 7%, p <0.04). In conclusion, in patients who have CAD, combination therapy with sildenafil and trimetazidine is more effective than nitrate therapy in the control of ischemic episodes during sexual activity, suggesting that long-term nitrate therapy may be safely switched to trimetazidine therapy when therapy for erectile dysfunction is required.