title: Targeting myocardial metabolism for the treatment of stable angina.
abstract: The goals of pharmacological treatment of stable angina pectoris are to improve quality of life by reducing the severity and/or frequency of symptoms and also the long-term prognosis. Patients with coronary artery disease have viable but dysfunctional myocardium. The metabolism of the ischemic myocardium is characterized by a shift from fatty acid to glucose as a preferred substrate and a decline in the levels of ATP. Targeting myocardial metabolism as a pharmacologic approach for chronic angina is based on the concept that metabolic adaptive mechanisms during ischemia resemble fetal energy metabolism by shifting substrate use towards glucose metabolism. Potential pharmacologic approaches should target i) the suppression of lipolysis and the plasma fatty acid levels and subsequent uptake and oxidation by the heart, ii) direct inhibition of the enzymes of fatty acid beta-oxidation, iii) inhibition of carnitine palmitoyl transferase- I (CPT-1). Currently, there are no approved medications directly targeting myocardial metabolism. However, in the last two years a number of medications indirectly targeting cardiac metabolism have been tested in small clinical trials, and some of them appear to be promising potential therapies for stable angina. This review summarizes the main aspects of myocardial metabolism and focuses on the therapeutic approaches that could offer clinical benefit in patients with stable angina.
authors.affiliation: 1st Cardiology Unit, Athens University Medical School, Greece. drtousoulis@hotmail.com
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tousoulis
authors.forename: Constantinos
authors.initials: C
authors.lastname: Bakogiannis
authors.forename: Alexandros
authors.initials: A
authors.lastname: Briasoulis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papageorgiou
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Androulakis
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Siasos
authors.forename: George
authors.initials: G
authors.lastname: Latsios
authors.forename: Anna-Maria
authors.initials: AM
authors.lastname: Kampoli
authors.forename: Marietta
authors.initials: M
authors.lastname: Charakida
authors.forename: Kostas
authors.initials: K
authors.lastname: Toutouzas
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000255:Adenosine Triphosphate / Q000378:metabolism; D000787:Angina Pectoris / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D009206:Myocardium / Q000378:metabolism*
chemical_list: D000255:Adenosine Triphosphate