Metabolic modulation: a new therapeutic target in treatment of heart failure.
Treatment of heart failure involves management of risk factors and control of symptoms. Traditional management of heart failure involves the use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, diuretics, aldosterone antagonists, and digitalis. Metabolic modulators are a newer class of drugs that benefit these patients by modulating cardiac metabolism without altering hemodynamics. They have the potential to relieve symptoms in patients with refractory heart failure who are already on optimal medical therapy. These drugs increase glucose metabolism at the expense of free fatty acid metabolism, thereby enhancing efficient use of oxygen. This review discusses the role of 4 metabolic modulators drugs that could potentially be used for heart failure therapy: trimetazidine, ranolazine, perhexiline, and etomoxir.
Palaniswamy
Chandrasekar
C
Department of Medicine, New York Medical College, Valhalla, 10595, USA. drpchandrasekar@gmail.com
Mellana
William Michael
WM
Selvaraj
Dhana R
DR
Mohan
Diwakar
D
D000083:Acetanilides / Q000627:therapeutic use; D002334:Carnitine O-Palmitoyltransferase / Q000037:antagonists & inhibitors; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D004852:Epoxy Compounds / Q000627:therapeutic use; D005227:Fatty Acids / Q000378:metabolism; D005947:Glucose / Q000378:metabolism; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism*; D006801:Humans; D008929:Mitochondria, Heart / Q000187:drug effects / Q000378:metabolism; D032383:Myocytes, Cardiac / Q000187:drug effects / Q000378:metabolism; D010480:Perhexiline / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D000069458:Ranolazine; D014292:Trimetazidine / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
D000083:Acetanilides; D004791:Enzyme Inhibitors; D004852:Epoxy Compounds; D005227:Fatty Acids; D010879:Piperazines; D014665:Vasodilator Agents; D000069458:Ranolazine; D002334:Carnitine O-Palmitoyltransferase; D005947:Glucose; D010480:Perhexiline; C054207:etomoxir; D014292:Trimetazidine