Mode of Action of Trimetazidine and Other New Metabolic Agents in the Treatment of Ischemic Heart Disease

摘要

The introduction of treatment modalities such as thrombocytic therapy, antiplatelet therapy, anticoagulation, angiotensin-converting enzyme (ACE) inhibition, lipid-lowering agents, beta-blockade, as well as other therapies, has dramatically altered the management of coronary artery disease in the last three decades. These therapies have greatly improved our ability to treat angina pectoris and acute myocardial infarctions as well as protect the heart during and following cardiac surgery. However, despite the differing mechanisms by which these pharmaco-logic agents work, they all basically have one of two major effects on the ischemic heart: they either increase oxygen supply or decrease oxygen demand.It has recently become clear that improving the efficiency of the heart in converting oxygen into contractile work is another option for the treatment of coronary artery disease. Metabolic modulation is one such approach to improving cardiac efficiency (see references 1 to 5 for reviews). In particular, switching energy metabolism from fatty acid to glucose oxidation improves cardiac efficiency.