Possibilities of using meldonium as part of complex therapy in patients with ischemic heart disease and chronic heart failure combined with obesity
Authors: Litvinova S.V. , Ostroumova O.D. , Kochetkov A.I. , Mironova E.V. , Sinitsyna I.I. 
Published: February 2025

Relevance. Cardiovascular diseases, including coronary heart disease (CHD), remain the leading causes of death worldwide. At the same time, concomitant obesity further increases the risk of adverse cardiovascular events (CVE) and complicates the management of these patients. One of the strategies aimed at increasing the effectiveness of CHD treatment is the use of metabolic therapy to ensure cardiocytoprotection. Aim. To study the effect of the drug Mildronate on the quality of life of patients with coronary heart disease and chronic heart failure (CHF) suffering from obesity. Material and methods. The multicenter, controlled, non-interventional study INDIKOR (Insulin resistance and diabetes mellitus as cardiovascular risk factors: metabolic correctors in combination therapy for coronary heart disease and/or chronic heart failure associated with metabolic syndrome or type 2 diabetes (T2D)) included 2084 patients, median age 62 (55;67) years, with a combination of two (or more) diagnoses (E66/E11+I20/I25/I50): E66 «Obesity»; E11 «Type 2 diabetes mellitus»; I20 «Angina pectoris»; I25 «Chronic ischemic heart disease»; I50 «Heart failure». The present subanalysis for obesity included 1295 patients with a diagnosis of E66 «Obesity». The patients included in the study were divided into 2 groups depending on from taking Mildronate: group 1 — basic therapy for the treatment of concomitant diseases (n=258), group 2 — basic therapy+Mildronate 1000 mg/day (n=1037). The duration of the observation period was 42±2 days. Results: when analyzing the results of the Seattle Angina Quality of Life Questionnaire, patients receiving Mildronate compared with the control group had a statistically significantly higher average total score on the following scales: attack frequency (78.1 [60; 100] versus 64 [40; 80] points, respectively, p<0.001), attack stability (91.8 [75; 100] versus 66.1 [50; 75] points, respectively, p<0.001), limitation of physical activity (53.6 [42.2; 64.4] versus 46 [35.6; 57.8] points, respectively, p<0.001), and satisfaction with treatment (75.1 [66.3; 88.8] versus 64 [48.8; 76.3] points, respectively, p<0.001). In the group of patients receiving Mildronate, a statistically significant decrease in the proportion of patients with of functional class (FC) IV (from 0.6% to 0%), FC III (from 15.9% to 2.1%) and FC II (from 51.1% to 40.2%) was observed compared to the control group (FC III — from 13.2% to 8.1% and FC II — from 50% to 45.3%) (p<0.001 between groups). In the group of patients taking Mildronate, a statistically significantly greater decrease in the total score on the subjective asthenia assessment scale (MFI-20) was observed compared to the control group (46.3 [38; 55] versus 63.3 [56; 71], p<0.001 between groups. Conclusion. The addition of Mildronate to combination therapy for the treatment of cardiovascular diseases for 42 days in obese patients with coronary heart disease and CHF is associated with a decrease in the severity of asthenia, an increase in satisfaction with treatment, a decrease in the frequency of attacks, and an improvement in the functional class of angina.