TREATING ISCHEMIC-HEART-DISEASE BY PHARMACOLOGICALLY IMPROVING CARDIAC ANERGY METABOLISM

An increasing number of clinical and experimental studies have shown t hat optimizing energy metabolism in the heart is an effective approach to decreasing the symptoms associated with myocardial ischemia, In pa rticular, increasing myocardial glucose metabolism can benefit heart f unction and/or lessen tissue injury, However, high levels of circulati ng fatty acids will markedly decrease glucose metabolism in the heart. These high levels of fatty acids occur in most clinically relevant co nditions of myocardial ischemia, and can contribute to the severity of ischemic injury. A number of pharmacologic agents are now available t hat directly stimulate myocardial glucose metabolism or indirectly sti mulate glucose metabolism secondary to an inhibition of fatty acid met abolism, One agent that appears to act by this mechanism is trimetazid ine, which we recently found stimulates glucose oxidation in isolated rat hearts perfused with high levels of fatty acids. Clinical studies have also shown that trimetazidine has cardioprotective effects in the setting of myocardial ischemia, As a result, optimizing energy metabo lism with agents such as trimetazidine may have considerable promise a s a new approach to treating cardiovascular disease. (C) 1998 by Excer pta Medica, Inc.