Abstract Trimetazidine has been known for years as being an effective, ‘‘patient-friendly’’, anti-anginal agent. Recent studies using the modified release formulation (Vastarel MR) have confirmed the efficacy of trimetazidine in stable ischemic heart disease and suggested that it can be beneficial in a number of cardiac conditions. Trimetazidine has been reported to have a favourable impact on the prognosis of patients surviving an ST-elevation myocardial infarction and to exert a cardioprotective effect in patients undergoing an ischemia-reperfusion sequence, such as patients submitted to PCI or CABG procedures. However, the most exciting perspectives come from the heart failure area, where a beneficial effect has been reported on quality of life and prognosis. Heart Metab. 2010;46:43–47.