Meldonium: Evidence Base for Efficacy in Treatment of Coronary Artery Disease
DOI: 10.32364/2587-6821-2026-10-1-6
Meldonium: Evidence Base for Efficacy in Treatment of Coronary Artery Disease
O.D. Ostroumova1,2, E.V. Shin1, A.I. Kochetkov1, A.A. Tyazhelnikov3, E.V. Mironova4, N.M. Doldo4
1Russian Medical Academy of Continuous Professional Education, Moscow,
Russian Federation
2Sechenov First Moscow State Medical University, Moscow, Russian Federation
3Pirogov Russian National Research Medical University, Moscow, Russian Federation
4Central Clinical Hospital "RZD-Meditsina", Moscow, Russian Federation
Background: in the real clinical practice of many countries, metabolic therapy for coronary artery disease (CAD) is still of interest. This is due to the fact that, despite optimal backbone therapy, symptoms of angina and reduced quality of life persist in some patients. Thus, additional management approaches should be developed.
Aim: to systematize and to summarize the results of clinical studies assessing efficacy and safety of meldonium in patients with CAD.
Materials and Methods: based on published open-access articles containing results of original studies focused on the role of meldonium in treatment of CAD patients including those with stable angina pectoris (SAP). A search identified 22 papers evaluating efficacy and safety of meldonium in CAD patients. The studies involved fr om 35 to 2084 patients with SAP (functional classes II-IV according to the Canadian Classification of Angina) or those with a history of myocardial infarction and/or myocardial revascularization surgeries with several comorbidities (chronic heart failure [CHF], hypertension, type 2 diabetes, obesity, or metabolic syndrome).
Results: studies with various designs (including double-blind placebo-controlled trials) demonstrated that in patients with CAD, meldonium added to standard therapy significantly reduced incidence of angina attacks, increased exercise tolerance (based on exercise stress test data), and lowered levels of low-density lipoprotein cholesterol and blood inflammation markers. A large observational study, INDICOR (n=2084), and its sub-analyses confirmed efficacy of meldonium for complex CAD patients with comorbidities (obesity, type 2 diabetes, CHF) in real-world clinical practice.
Conclusion: the evidence base for meldonium use in CAD patients indicates its efficacy for various treatment regimens (oral use only or intravenous use followed by oral administration) and in different patient subgroups (SAP patients, patients with a history of various myocardial revascularization surgeries, and stable patients early after myocardial infarction). The data also suggest the potential of meldonium in cardiac rehabilitation wh ere it may help improve the functional status of patients after a percutaneous coronary intervention and coronary artery bypass grafting.
Keywords: coronary artery disease, stable angina pectoris, myocardial revascularization, chronic heart failure, quality of life, meldonium.
For citation: Ostroumova O.D., Shin E.V., Kochetkov A.I., Tyazhelnikov A.A., Mironova E.V., Doldo N.M. Meldonium: Evidence Base for Efficacy in Treatment of Coronary Artery Disease. Russian Medical Inquiry. 2026;10(1):39–50 (in Russ.). DOI: 10.32364/2587-6821-2026-10-1-6
ABOUT THE AUTHORS:
Olga D. Ostroumova — Dr. Sc. (Med.), Professor, Head of the Academician M.S. Vovsi Department of Therapy and Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education; 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation; Professor of the Department of Clinical Pharmacology and Propedeutics of Internal Diseases, Sechenov First Moscow State Medical University; 8 Build. 2, Trubetskaya str., Moscow, 119991, Russian Federation; ORCID iD 0000-0002-0795-8225
Elena V. Shin — C. Sc. (Med.), Associate Professor at the Academician M.S. Vovsi Department of Therapy and
Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education; 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0009-0000-4591-3266
Alexey I. Kochetkov — C. Sc. (Med.), Associate Professor at the Academician M.S. Vovsi Department of Therapy and Polymorbid Pathology, Russian Medical Academy of Continuous Professional Education; 2/1, Barrikadnaya str., Moscow, 125993, Russian Federation; ORCID iD 0000-0001-5801-3742
Andrey A. Tyazhelnikov — Dr. Sc. (Med.), Associate Professor, Professor at the Yu.P. Lisitsin Department of Public Health and Healthcare, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117513, Russian Federation; ORCID iD 0000-0002-2191-0623
Elena V. Mironova — C. Sc. (Med.), Cardiologist, Head of the Cardiology Department of the Central Clinical Hospital "RZD-Meditsina"; 84, Volokolamskoe road, Moscow, 125367, Russian Federation; ORCID iD 0000-0002-2988-1767
Nikolay M. Doldo — Cardiologist, Head of the Therapeutic Department of the Central Clinical Hospital "RZD-Meditsina"; 84, Volokolamskoe road, Moscow, 125367, Russian Federation; ORCID iD 0000-0003-2546-1340
Contact information: Olga D. Ostroumova, e-mail: ostroumova.olga@mail.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 12.01.2026.
Revised 04.02.2026.
Accepted 02.03.2026.
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