Choice of p-fox inhibitor as actual therapeutic strategy in correction of cardiometabolic disorders

Abstract

In the modern world, there is a steady increase in the number of patients with diseases pathogenetically associated with insulin resistance and metabolic syndrome, which represent a springboard for the development of not only cardiovascular, but also other socially significant chronic non-communicable diseases. The study of the pathogenetic interaction of numerous humoral and physical factors in the development and progression of vascular-metabolic disorders is the most relevant area of modern clinical research. Over the past decades, there has been a surge of interest in the scientific literature and a detailed discussion of current trends in the development of diseases and conditions associated with insulin resistance and metabolic syndrome, as well as their associated complications in various fields of medicine. Models of the interaction of neurohumoral, metabolic, vascular and other factors proposed by experts are important for understanding the processes leading to an increase in the prevalence of conditions associated with insulin resistance. Carrying out reciprocal interaction with the developing vascular and metabolic complications of diabetes mellitus and obesity, cellular metabolic disorders should become a new therapeutic target for improving the condition and prognosis of patients. A promising direction in the correction of intracellular metabolic disorders is the use of drugs that block the partial oxidation of free fatty acids in mitochondria (partial fatty and oxidation inhibitors) – p-fox inhibitors, which include the most commonly used in modern clinical practice trimetazidine and meldonium. A wide range of comorbid conditions and various chronic diseases in most patients dictates the need for a detailed study of the mechanisms and features of action, as well as drug-drug interactions of these drugs. There is also a need to discuss the possible risks of side effects that may limit the use of some p-fox inhibitors. This review provides a discussion of these issues in relation to trimetazidine and meldonium, as well as an assessment of various options for their safe clinical use.