Metabolic modulators for chronic cardiac ischemia.
Many patients with ischemic heart disease continue to experience anginal symptoms despite revascularization and treatment with antianginal medications. The effectiveness of current anti-ischemic medications is limited by their hemodynamic side effects, such as hypotension and bradycardia, which result in compromised organ perfusion. In this article, we review five novel agents (ranolazine, trimetazidine, L-carnitine, ribose, and dichloroacetate) under investigation for treatment of ischemic heart disease that work by enhancing the efficiency of the myocardium, rather than decreasing its work. This new paradigm promises to eliminate these side effects.
Parang
Pirouz
P
Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Singh
Bramah
B
Arora
Rohit
R
D000083:Acetanilides; D000818:Animals; D002331:Carnitine / Q000494:pharmacology / Q000627:therapeutic use; D002908:Chronic Disease; D004353:Drug Evaluation, Preclinical; D004791:Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D006321:Heart / Q000187:drug effects; D006801:Humans; D050356:Lipid Metabolism / Q000187:drug effects; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000378:metabolism; D009206:Myocardium / Q000378:metabolism; D010879:Piperazines / Q000494:pharmacology / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D000069458:Ranolazine; D014292:Trimetazidine / Q000494:pharmacology / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use; D014803:Vitamin B Complex / Q000494:pharmacology / Q000627:therapeutic use
D000083:Acetanilides; D004791:Enzyme Inhibitors; D010879:Piperazines; D014665:Vasodilator Agents; D014803:Vitamin B Complex; D000069458:Ranolazine; D014292:Trimetazidine; D002331:Carnitine