Methabolic therapy of coronary artery disease. Therapy of coronary artery disease includes strategies which reduce the incidence of adverse clinical outcomes and relieve symptoms improving exercise tolerance. Aspirin, statins, aceinhibitors are effective drugs in atherosclerosis prophylaxis. The other aspect of treatment is using anti-anginal drugs; nitrates, beta-arenolytics and calcium antagonists which effecacy is often limited, also by adverse events. The concept of metabolic modulators to treat myocardial ischemia and angina pectoris is a newer therapeutic option. Trimetazidine, metabolic agent, is being used with increased frequency in European and Asian countries. Its efficacy has been confirmed in many comparative studies in patients with ischemic heart disease. It has excellent safety profile and practically no specific adverse events. The other therapeutic opinion is using trimetazidine in refractory angina and in patients with concomitant diabetes and heart failure. Another metabolic drug under clinical investigation is ranolazine.