Metabolic modulation of myocardial ischemia

The metabolic pathways of the heart during normoxia and ischemia have been well studied. High plasma fatty acid concentrations and the myocardial accumulation of long-chain fatty acyl metabolites during ischemia correlate with increased morbidity and mortality. However, enhanced glucose use can maintain cell homeostasis, diminish ischemic injury, and be clinically beneficial. Metabolic modulators represent a new class of drugs with the potential to treat myocardial ischemia. They are ideal as adjunctive anti-ischemic therapy because they lack the hemodynamic consequences of traditional therapy and treat the underlying metabolic dysfunction that leads to contractile failure and arrhythmias. Clinical studies have demonstrated their efficacy in acute and chronic settings. It is anticipated that there will be greater utilization of this new class of agents in the near future.