Optimizing cardiac energy metabolism: how can fatty acid and carbohydrate metabolism be manipulated?

Optimizing energy metabolism in the heart is a novel approach for the management of ischaemic heart disease, especially in conjunction with optimizing or restoring coronary flow. In particular, promoting myocardial glucose metabolism can enhance heart function, lessen injury to tissue, or both. Several pharmacological agents that directly stimulate myocardial glucose oxidation or indirectly stimulate glucose oxidation secondary to inhibition of oxidation of fatty acids are now available. Trimetazidine is the first compound in the class of 3-ketoacyl-coenzyme A thiolase inhibitors to see wide-spread clinical use. This agent increases glucose metabolism in the heart secondary to a direct inhibition of fatty acid metabolism. Considering results of experimental and clinical studies on other agents, it is clear that metabolic agents may provide a new approach to treating cardiovascular disease that should complement and improve existing therapies.