Management of ischaemic heart disease in diabetic patients--is there a role for cardiac metabolic agents?

Diabetes mellitus (DM) increases the risk of cardiovascular events in patients with cardiovascular disease as well as in patients without any previous history of ischaemic heart disease (IHD). The management of IHD in diabetic patients remains a difficult challenge. However, some of these treatments are not as effective or well-tolerated in diabetic patients as in non-diabetic patients. An important effect of diabetes, that in turn influences cardiac function, is the switch from carbohydrate oxidation to free fatty acid and ketone oxidation. The correction of the alterations to cardiac metabolism associated with DM may represent a new approach to the management of IHD in these patients. Results obtained in anginal patients with the metabolic agent trimetazidine and in infarcted patients with glucose-insulin-potassium (GIK) are consistent with this hypothesis.