Beijing time on November 24, The Anti-Doping Center of the State General Administration of Sports released an explosive news on its official website. Chinese swimmer Sun Yang, The news that Sun Yang was banned for 3 months and fined after a positive doping test in the National Swimming Championship caused a sensation in the media at home and abroad. Some media believed that Sun Yang should be banned for at least 2 years and was not eligible to participate in the Asian Games. The previously controversial swimming genius has once again become the focus.
Instead of commenting hastily, it is not too late to start with the drug involved [trimetazidine] and learn some background knowledge before expressing your views.
Trimetazidine is a what drug?
[Trimetazidine] is a cardiovascular drug, the commercial name is [Wanshuangli], is very commonly used in clinical prescription drugs, cardiovascular doctors are familiar with it. In a word, trimetazidine is mainly used to improve myocardial ischemia.
1. Is what [myocardial ischemia]?
The heart beats vigorously 24 hours a day and needs to consume a large amount of energy and oxygen continuously. These energies are supplied through the blood in the coronary artery. Once the blood supply is insufficient, angina pectoris will occur in mild cases, heart function will be affected in severe cases, and even myocardial infarction will occur.
Therefore, various problems in coronary arteries may cause myocardial ischemia.
2. Therapeutic effect of trimetazidine on myocardial ischemia
Trimetazidine is very targeted for this myocardial ischemia. It can dilate coronary arteries, increase blood supply to the heart, improve energy metabolism of the heart, reduce the consumption of energy and oxygen by the heart, relieve the shortage of energy and oxygen, and then reduce the burden on the heart.
Therefore, at first this drug was mainly prescribed for long-term use by patients with coronary heart disease and angina pectoris.
3. [Myocardial Protective Effect] of Trimetazidine
Trimetazidine was a hot drug in cardiology research in the 1990s. Studies have found that long-term administration of trimetazidine can not only significantly reduce the onset of angina pectoris, but also significantly improve patients with cardiac insufficiency. Therefore, doctors often prescribe this drug for many patients who do not have coronary heart disease but want to improve myocardial blood supply and functional ability, and summarize the [myocardial protection effect] of this drug.
Trimetazidine has few side effects and is a safer drug to take for a long time. Recently, the drug administration warned against dyskinesia caused by trimetazidine, [Parkinson’s symptoms], but the probability of occurrence is actually very small.
Can trimetazidine improve athletic performance?
As a specialist, it can be said with certainty that for patients who are determined to have ischemic heart disease, long-term administration of trimetazidine can significantly improve their exercise ability, both endurance and exercise intensity.
However, for healthy people and even athletes, There is little direct evidence of this. We can only infer from some indirect facts. For example, trimetazidine used for 3 months in patients with peripheral vascular diseases but no heart problems improved their exercise endurance without improvement of peripheral vascular diseases.
Then, for completely healthy people, it may also have positive effects.
In addition, the relevant manufacturers told me that they did hear rumors that some sports teams had allowed athletes to take trimetazidine as a [supplement] for a long time in order to improve their competition results.
Since there is no targeted research, it is not clear for the time being whether this shortcut idea can be fulfilled and whether the record of some athletes is related to taking medicine.
However, in January 2014, trimetazidine was listed as a drug banned by the World Anti-Doping Organization for the first time during the competition. This also supports rumors that sports teams use it as a supplement.
Why does Sun Yang take trimetazidine?
Yesterday, Sun Yang issued a brief statement on Weibo, saying that his heart often suffered from discomfort. The hospital diagnosed that the virus infected the myocardium and caused myocardial ischemia, so the doctor prescribed the medicine and he took it for a long time.
Judging from the above information alone, there are many doubts about such a statement.
1. If we want to consider [virus infects myocardium], it is basically viral myocarditis.
This is a menacing heart disease. Trimetazidine may be used in treatment. After recovery, if there are no major sequelae, it does not need to be taken for a long time. If there are sequelae, then the ability of high-intensity exercise is worth considering.
2. If [virus infection] is only a guess about the cause of the disease, is Sun Yang with cardiac discomfort and [myocardial ischemia] suitable for taking trimetazidine for a long time?
In fact, in the outpatient department of cardiology, Nearly half of the patients said that their heart was unwell, but they could not find any organic pathological changes or evidence of myocardial ischemia. There are also quite a number of patients who simply look like myocardial ischemia on electrocardiogram, but they are young and have no obvious high-risk factors. Then we still do not diagnose it so easily, let alone take drugs easily.
On November 24, Zhejiang Swimming Association issued a circular [1]:
[According to the survey, In November 2008, Sun Yang suffered from chest tightness, palpitation and discomfort after catching a cold. After expert consultation, it was believed that there was myocardial ischemia in Sun Yang, It is related to myocardial damage caused by cold virus infection, “Wan Shuang Li” was taken to treat myocardial ischemia and protect myocardium. In the following years, Sun Yang occasionally suffered from chest tightness, palpitations and discomfort after heavy exercise training. For the purpose of treating cardiac ischemia and protecting myocardium, Sun Yang took “Wan Shuang Li” according to the advice of specialists. The symptoms improved obviously and the protection of the heart was ideal.]
If the information in this news is true, it is reasonable to take this medicine although it is not within the indication. However, I am afraid it will need further evaluation before we know whether we still need to continue taking the medicine now.
3. Trimetazidine was only included in the list of banned drugs for athletes this year.
Perhaps that’s how some athletes were recruited, such as Ukrainian skier Lisogor, who was found to have taken trimetazidine. Some sports medicine experts believe trimetazidine should not be banned as an athlete because it is like vitamin C.
Of course, we can understand that the anti-doping organization, out of consideration of fairness in the competition, forbids taking this drug during the competition, which is reasonable. At the same time, it is also a protection for athletes. After all, this drug is not designed for healthy people. At the same time, athletes should also strictly abide by the norms and voluntarily report their medication, so as to avoid misunderstanding.