New therapeutic targets for myocardial infarction

摘要

Coronary artery disease (CAD) is the most common cause of morbidity and mortality worldwide and is projected to be the leading cause of death and disability worldwide by 2020. CAD contributes 30.9% of global mortality and 10.3% of global burden of diseases. In the Indian population, incidence of CAD among the younger generation is quite high (up to 12-16%) compared to the Western population (5%). Sedentary and stressful lifestyle has been suggested as an important risk factor for CAD, along with the conventional risk factors such as hypertension, diabetes mellitus, hypertriglyceridaemia, high levels of LDL-cholesterol, central obesity and low levels of HDL-cholesterol. CAD is characterized by insufficient blood supply to regions of the myocardium,which can lead to development of necrosed zones that are ultimately replaced by fibrous tissue. Reperfusion is one of the mechanisms of restoring blood supply to ischaemic myocardium and limiting myocardial damage. However, it is associated with cell death which further increases complications such as diminished cardiac contractile functions and arrhythmias. The phenomenon is named as ischaemia reperfusion injury. Although therapy for CAD has entered a new era, most of the current therapies were developed in the absence of defined molecular targets. Increasing knowledge of the biochemical and cellular alterations occurring in myocardial infarction (MI) has led to the development of novel and potentially more effective therapeutic approaches to treat the disease. The role of peroxisome-proliferator-activated receptors (PPARs) and K-ATP channel blockers in the treatment of MI has been documented. However, many promising molecules, especially the anti-apoptotic drugs, phosphodiesterase-5 inhibitors areyet to be approved due to safety issues. Meanwhile, two targets gene therapy and inhibitors of Na+/H+ exchanger have emerged as validated targets for the pharmacotherapy of MI. The present review discusses the different functional targets which are currently being used or bear potential as treatment for MI.