On November 24, 2014, CCTV and other media reported a news that China’s famous swimmer Sun Yang was found to have used the banned substance “Trimetazidine” in a urine test on May 17, and was banned for 3 months from May 17 to August 16, announced by the Anti-Doping Center of the State General Administration of Sports on November 24. At the same time, Sun Yang’s 1500m title in the national swimming championship was cancelled and fined 5,000 yuan. For athletes to use prohibited drugs incident we basically reflect the cold, in recent years, such incidents are commonplace. Whether it is subjective intention, or objective reasons, the use of prohibited drugs 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, here I would like to give you an answer one by one. 1.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 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. 2. What are Stimulants? The definition of “Stimulants” is as follows: “Stimulants directly affect the central nervous system, increasing blood flow and heart rate”. Obviously, trimetazidine does not belong to the category of stimulants. 3. Why is Vancomycin classified 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. Because of 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 drug in January 2014, and its official webpage on the listing of trimetazidine as a prohibited drug in competition reads: “trimetazidine have been added as examples to reflect emerging patterns of drug use. ” (Trimetazidine has been added to the list of prohibited drugs in response to emerging and increasing use of drugs such as trimetazidine by athletes). 4. Trimetazidine is listed as a prohibited drug for athletes, so can it be applied to patients with coronary artery disease? 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 in order to generate more energy supply, thus to control myocardial ischemia and improve 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, it is important not to deny the value of trimetazidine in patients with coronary heart disease and myocardial ischemia just because it is banned in athletes. The domestic cardiovascular authority, well-known professor Hu Dayi in an interview clearly said “for symptomatic patients with coronary heart disease, doctors prescribed trimetazidine is reasonable, and the safety of the drug is good, patients do not need to worry” 5, misuse of prohibited drugs in the wrong side? From the incident of Sun Yang, we can easily see that our athletes and supporting staff still have a lack of awareness of prohibited drugs in sports. If the team doctor had carefully studied the new WADA Prohibited List and found out that the “Wanshangli” used by Sun Yang to treat myocardial ischemia was already a prohibited drug in-competition, the doping incident would not have happened; if Sun Yang had declared that he was using the drug in accordance with anti-doping regulations when he underwent the doping test, the positive result would not have been established. It was carelessness, disregard, and disrespect for anti-doping rules that led to the positive result, and the inevitable in the accidental ending. For drugs, we must always have a “fear” attitude, any drug before the market has undergone strict clinical validation, and there are corresponding indications for the application, only to firmly grasp the application of guidelines, rational use of drugs to benefit patients. 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.