Background. In recent years, metabolic or cytoprotective agents have been actively studied, which can increase the efficiency of oxy- gen utilization by the myocardium under ischemia without affecting hemodynamic parameters. The trimetazidine is most studied in this group of drugs, which is reflected in the clinical guidelines for the treatment of coronary pathology and heart failure. The frequent com- bination of coronary artery disease (CAD) with comorbid pathology makes it relevant to study the use of trimetazidine in such patients. Description of the clinical case. The 57-year-old man had been suffering from coronary artery disease, arterial hypertension, type 2 diabetes mellitus, and gout for a long time. In 2009, CAD was verified and coronary artery bypass grafting was performed. The reason for contacting a cardiologist was the deterioration of health in the form of shortness of breath that occurs with severe physical exertion against the background of drug therapy. Echocardiography revealed concentric left ventricle hypertrophy and 1 degree left ventricle diastolic dysfunction without increasing filling pressure with normal ejection fraction. Stress echocardiography with treadmill test veri- fied painless myocardial ischemia. Against the background of 3-month combined anti-ischemic therapy, which included bisoprolol and trimetazidine, clinical improvement and an anti-ischemic effect were noted according to repeated stress echocardiography.
Conclusion. Thus, the use of trimetazidine in the complex therapy of coronary artery disease in the presence of comorbid cardiovascu- lar pathology and metabolic disorders can both help potentiate the antianginal effect and have a positive effect on the course of heart failure.

Keywords: coronaryartery disease, comorbidity, trimetazidine, diabetes mellitus, metabolic syndrome, heart failure