[Treating ischemic heart disease by pharmacologically improving cardiac energy metabolism]

THE ISCHEMIA-ENERGY RELATIONSHIP: A growing number of experimental and clinical studies have demonstrated that improving heart energy metabolism can have a positive effect on the consequences of myocardial ischemia. By enhancing myocardial carbohydrate metabolism, it is possible to improve cardiac function and/or limit tissue damage. It is known however that a high level of circulating fatty acids reduces myocardial glucose metabolism, a situation which is observed in most cases of symptomatic myocardial ischemia and which can further aggravate ischemic damage. PHARMACOLOGICAL OPTIONS: A certain number of pharmacological possibilities are available for stimulating glucose metabolism directly or indirectly by inhibiting fatty acid beta-oxidation. The effect of trimetazidine is based on this action and we have recently demonstrated in isolated perfused rat hearts with high concentrations of fatty acids that trimetazidine stimulates glucose oxidation. Clinical studies have also demonstrated that trimetazidine has a protective effect on heart tissue during episodes of myocardial ischemia. Pharmacologically improving cardiac energy metabolism with drugs such as trimetazidine could be a new promising approach to the treatment of cardiovascular diseases.