The use of banned substances by athletes has largely been met with indifference, and in recent years such incidents have been commonplace. Whether subjective or objective, the use of banned substances is a serious violation of the principle of fair play for athletes. The incident was not given much attention, but suddenly found that the public, especially patients, expressed a high degree of concern. The reason for this concern is not the incident itself, but whether the drug is harmful to the human body. In my recent clinic, I was asked by patients, “Is this drug a stimulant? Is this drug a drug? Is it addictive if applied for a long time? Is it harmful to human body? In response to these questions, I would like to give you an answer one by one. I. What kind of drug is Trimetazidine? Before explaining these questions, let’s first understand what kind of drug Trimetazidine is? I think all cardiovascular doctors are familiar with this drug. It is one of the most commonly used drugs for coronary heart disease and has the ability to improve the symptoms of myocardial ischemia and nourish the heart muscle. The original manufacturer of this drug is the French company Schweizer, and the trade name is “Vansonix”, so the name is full of energy, right? As we all know, each drug has its own mechanism of action, and trimetazidine is certainly no exception. It can improve myocardial energy metabolism and increase the heart’s ability to tolerate ischemia and hypoxia, and is often used clinically in the treatment of angina pectoris and old myocardial infarction. So how exactly does this drug work? First, let’s learn about the energy supply of the heart. 60% to 70% of the normal myocardial energy (ATP) supply comes from beta oxidation of free fatty acids, 20% to 25% from glucose oxidation, and 5% to 10% from glycolysis. What is the difference between these three energy pathways? The oxygen consumption of free fatty acid oxidation to produce an equivalent amount of ATP is higher than that of glucose oxidation. In other words, with the same amount of oxygen supply, more energy can be obtained through the glucose oxidation pathway, which is not usually seen, but is especially important in cases of coronary heart disease and insufficient oxygen supply to the heart muscle. In contrast, trimetazidine inhibits free fatty acid metabolism, thus allowing the myocardium to produce energy mainly by glucose metabolism, improving oxygen utilization and producing more high-energy phosphate bonds to relieve myocardial ischemic symptoms and maintain myocardial survival and cardiac function when myocardial oxygen supply is limited by coronary artery disease. This is the basis for the use of trimetazidine in patients with coronary artery disease. What is a stimulant/prohibited substance? Stimulants are defined as drugs that directly affect the central nervous system and increase blood flow and heart rate. Obviously, trimetazidine does not belong to the category of stimulants. Why is Vancomycin listed as a prohibited drug? Recent studies have shown that trimetazidine has an optimal effect on the energy metabolic process of skeletal muscle cells similar to that of cardiac muscle, and it can significantly improve the exercise tolerance of patients with ischemic cardiomyopathy by increasing the efficiency of oxygen utilization by cardiac and skeletal muscle. Due to the beneficial effects of trimetazidine on myocardial and skeletal muscle cell energy metabolism that may enhance athletes’ performance, the World Anti-Doping Agency (WADA) listed trimetazidine as a prohibited substance in January 2014, and its official webpage states the following regarding the listing of trimetazidine as a prohibited substance in competition: In response to the emerging and increasing number of athletes In response to the emerging and increasing use of trimetazidine and other drugs by athletes, trimetazidine has been added to the list of prohibited drugs. As mentioned above, trimetazidine is different from “stimulants” in that it has no central excitatory effect. It is mainly used to optimize myocardial energy metabolism and improve the efficiency of oxygen utilization by the body to produce more energy supply, thus achieving the effect of controlling myocardial ischemia and improving angina attacks. And its improvement of exercise tolerance can help patients improve their quality of life, restore social function and even improve their prognosis. Therefore, do not deny the value of trimetazidine in patients with coronary artery disease and myocardial ischemia because it is banned in athletes. V. What is wrong with taking prohibited drugs by mistake? We must always have a “reverent” attitude towards drugs. Any drug has undergone strict clinical validation before it is marketed and has corresponding indications for application. For athletes, in addition to following medical advice to take medication, they also need to remind doctors and themselves of the prohibited drugs that they need to be aware of as athletes to maintain the fairness and purity of sports.