Evaluation of Effects of Stepwise and Oral Mildronate Therapy on Neurological Status, Cognitive Functions, and Asthenic Syndrome in Patients with Cardiovascular Comorbidities
Developing and enhancing pathogenesis-based treatment of chronic progressive cardiovascular and cerebrovascular diseases present as one the most relevant trends in the modern medicine. The issue of cognitive impairment occurring in chronic cerebrovascular disease in cardiovascular pathology is of particular medical and social significance. Given the high risk of possible polypharmacy in such clinical cases with comorbidities, it is preferable to use combinations of drugs, for which there are multiple indications. In this article, we provide examples of such drugs which are partial fatty acid oxidation inhibitors. We review in detail the therapeutic mechanism of action of meldonium, a drug which belongs to this pharmacological class, emphasizing its efficacy and treatment results in ischemic brain diseases. We cover the design and results of the observational non-interventional multicenter trial STEM, carried out by a group of authors in order to evaluate the effect of stepwise and oral therapy with meldonium (Mildronate) on neurological status, cognitive functions, and asthenic syndrome in patients with chronic cerebrovascular insufficiency and concomitant ischemic heart disease in outpatient settings. This study revealed that adding Mildronate to the treatment regimen led to a significant reduction of headache intensity, dizziness, asthenia and emotional disturbances in patients with cardiovascular comorbidities. Also, a significant improvement in static balance and coordination disorders was observed. Furthermore, stepwise therapy with Mildronate more often resulted in complete symptom elimination, than oral treatment regimen. The obtained clinical data confirm the utility of this drug agent in the complex treatment of patients with vascular comorbidities.