Additional antiischemic effects of long-term L-propionylcarnitine in anginal patients treated with conventional antianginal therapy
- 35 Downloads
Cardiac L-carnitine content, essential for mitochondrial fatty acid transport and ATP-ADP exchange, decreases during ischemia. In animal models, administration of the natural derivative, L-propionylcarnitine, may reduce ischemia and improve cardiac function. To evaluate possible antiischemic effects of L-propionylcarnitine in patients on maximal antianginal therapy, L-propionylcarnitine was compared with placebo in a randomized, double-blind, parallel design, in addition to preexisting therapy. Patients with ≥2 anginal attacks per week and objective signs of ischemia with angina during bicycle exercise testing were included. After an initial 2-week, single-blind placebo phase, 37 patients received 500 mg L-propionylcarnitine tid, and 37 patients received placebo for 6 weeks. Both groups were comparable at baseline. Three patients discontinued the study while on placebo (two because of noncompliance, one because of palpitations) and one while on L-propionylcarnitine (noncompliance). Although heart rate, blood pressure at rest, and maximal exercise were not affected, L-propionylcarnitine increased the time to 0.1 mV ST-segment depression [44±3 vs. 8±2 seconds (\((\bar x \pm SEM)\)) in the placebo group; p=0.05], and exercise duration improved by 5% compared with placebo. Anginal attacks and the consumption of nitroglycerin were not affected in either group. Thus, following a 6 week treatment period, L-propionylcarnitine induced additional, albeit marginal, antiischemic effects in anginal patients who were still symptomatic despite maximal conventional antianginal therapy. It is questionable whether in these patients this form of metabolic treatment will achieve great benefit, although in some improvement can be expected.
Key WordsL-propionylcarnitine angina ischemia long term
Unable to display preview. Download preview PDF.
- 2.Spagnoli LG, Corsi M, Villaschi S, Palmieri G, Maccari F. Myocardial carnitine deficiency in acute myocardial infarction.Lancet 1982;1:1419–1420.Google Scholar
- 5.Cacciatore L, Cerio R, Ciarimboli M, et al. The therapeutic effects of L-carnitine in patients with exercise-induced stable angina: A controlled study.Drugs Expt Clin Res 1991;17:225–235.Google Scholar
- 6.Chaitman B. Exercise stress testing in heart disease. In: Braunwald E, ed.A Textbook of Cardiovascular Medicine. Philadelphia: WB Saunders, 1992:161–179.Google Scholar
- 7.Cherchi A, Lai C, Angelino F, et al. Effects of L-carnitine on exercise tolerance in chronic stable angina: A multicenter, double-blind, randomized, placebo controlled crossover study.Clin Pharm Therap Toxicol 1985;23:569–572.Google Scholar