What Is the Heart Drug Behind the Olympic Skating Controversy? – Everyday Health

The 15-year-old Russian figure skater Kamila Valieva had already made headlines at the Olympics in Beijing for landing two quadruple jumps on February 7, a feat no other female competitor has ever pulled off at the games.

Then came the news that a doping test shed taken in advance of a competition in December 2021 showed signs of trimetazidine (TMZ), a heart medication that has been banned by the World Anti-Doping Agency since 2014.

The Court of Arbitration for Sport ruled on February 14 that Valieva could continue to compete in the games; the International Olympic Committee announced that she will not be eligible for any medals until her case is resolved.

While its hard to predict how events will play out, heres whats known about the drug at the heart of the controversy, and some input from a sports medicine doctor on whether this medication can give athletes an edge.

Trimetazidine has been widely used in some European countries since the 1970s but is not approved in the United States. Doctors prescribe the drug to treat chest pain (angina) when more standard medications such as aspirin or beta-blockers arent working. Physicians also prescribe TMZ to treat ringing in the ears (tinnitus), dizziness (vertigo), and some vision disturbances.

Angina occurs when arteries fail to deliver enough blood to a part of the heart that needs oxygen. Though the pain often goes away with rest, angina is usually a warning sign of heart disease.

Though some studies have shown that trimetazidine works well as an adjunct to or alternative to standard treatments for angina, there have been very few randomized double-blind trials of TMZ, and studies that do exist have had conflicting results.

The medication can cause side effects such as restless legs and other movement issues similar to symptoms of Parkinsons disease. Because of these side effects, in 2012, the European Medicines Agency (EMA) recommended that doctors limit the use of TMZ for angina and stop prescribing it to treat other conditions.

Trimetazidine helps the heart work more efficiently by making it easier to access energy.

Normally, the heart gets the energy it needs first by oxidizing fatty acids, then by utilizing glucose as energy a faster and more efficient process.

What trimetazidine does is decrease reliance on the slower fatty acids path and encourage more immediate glucose use, increasing the hearts efficiency. This is helpful for people with angina whose hearts may be deprived of adequate oxygen.

In a study published in a 2018 issue of Advances in Therapy, patients with recently diagnosed angina had fewer incidences of chest pain and were also able to increase their walking distance after being treated with the drug.

Trimetazidine is thought to give endurance athletes a boost because it may help the heart work more efficiently.

TMZ enhances the bodys ability to utilize oxygen under stress. Theoretically, that could provide an athlete in competition and under physical stress with an advantage, enabling them to utilize more oxygen than they normally would, says Cayce Onks, DO, a primary care sports medicine physician at Penn State Health Milton S. Hershey Medical Center in Hershey, Pennsylvania.

Thats precisely why it has been banned, though the connection between TMZ and improved performance is still largely theoretical. All Olympic athletes are looking for an edge, says Dr. Onks. When youre talking about a few extra seconds in the air, or a microseconds difference in a race, any advantage can be beneficial.

Unlike some other banned performance-enhancing drugs, like beta-blockers, TMZ does its work without affecting heart rate or blood pressure, explains Onks. Beta-blockers, on the other hand, can slow heart rate and lower blood pressure, obviously a negative for athletes.

As for Valieva, Onks agrees that a clear violation of doping rules occurred. There is no reason for a healthy 15-year-old to be on this medication, he says.

Onks does think the drug might help an athlete get to gold. The difference between first and second place, at this level, can be so infinitesimal that its not measurable, says Onks. Well just never really know the role TMZ might play in terms of that edge.

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What Is the Heart Drug Behind the Olympic Skating Controversy? - Everyday Health