Modification of myocardial substrate utilisation: a new therapeutic paradigm in cardiovascular disease
- PMID: 20478861
- DOI: 10.1136/hrt.2009.190256
Modification of myocardial substrate utilisation: a new therapeutic paradigm in cardiovascular disease
Abstract
Therapies that aim to modify cardiac substrate utilisation are designed to increase metabolic efficiency. Although the main energy supply for the heart is generally provided by the oxidation of fatty acids, the heart is a metabolic omnivore and able to consume glucose as well as lactate and amino acids in varying proportions. A shift from fatty acid oxidation to glucose oxidation leads to lower oxygen consumption per unit of ATP produced. This concept of reduced oxygen utilisation underlies the use of metabolic modulating agents to treat chronic stable angina. Furthermore, the model of an energy-starved heart now forms the basis for our understanding of both ischaemic and non-ischaemic heart failure. Potential alterations in substrate utilisation and thus myocardial efficiency underlie the use of metabolic agents in heart failure. This is achieved by either promoting glucose or reducing the utilisation of fatty acids. Such a shift results in a relatively greater production of ATP per unit of oxygen consumed. With an ongoing demand for treatment options in ischaemic heart disease and a growing epidemic of heart failure, new treatment modalities beyond contemporary therapy need consideration.
Similar articles
-
Inhibition of free fatty acids metabolism as a therapeutic target in patients with heart failure.Int J Clin Pract. 2007 Apr;61(4):603-10. doi: 10.1111/j.1742-1241.2006.01280.x. Int J Clin Pract. 2007. PMID: 17394434 Review.
-
Energetic myocardial metabolism and oxidative stress: let's make them our friends in the fight against heart failure.Biomed Pharmacother. 2010 Mar;64(3):203-7. doi: 10.1016/j.biopha.2009.10.002. Epub 2009 Nov 13. Biomed Pharmacother. 2010. PMID: 19954925 Review.
-
Anti-anginal effects of partial fatty acid oxidation inhibitors.Curr Opin Pharmacol. 2007 Apr;7(2):179-85. doi: 10.1016/j.coph.2006.10.008. Epub 2007 Feb 20. Curr Opin Pharmacol. 2007. PMID: 17307396 Review.
-
Cardiac energetics during ischaemia and the rationale for metabolic interventions.Coron Artery Dis. 2001 Feb;12 Suppl 1:S3-7. Coron Artery Dis. 2001. PMID: 11286306 Review.
-
Metabolic therapy for the treatment of ischemic heart disease: reality and expectations.Expert Rev Cardiovasc Ther. 2007 Nov;5(6):1123-34. doi: 10.1586/14779072.5.6.1123. Expert Rev Cardiovasc Ther. 2007. PMID: 18035928 Review.
Cited by
-
Experimental and clinical evidences for glucose control in intensive care: is infused glucose the key point for study interpretation?Crit Care. 2014 Jul 23;18(4):232. doi: 10.1186/cc13998. Crit Care. 2014. PMID: 25177798 Free PMC article. Review.
-
Sepsis-associated hyperlactatemia.Crit Care. 2014 Sep 9;18(5):503. doi: 10.1186/s13054-014-0503-3. Crit Care. 2014. PMID: 25394679 Free PMC article. Review.
-
Targeting Adrenergic Receptors in Metabolic Therapies for Heart Failure.Int J Mol Sci. 2021 May 28;22(11):5783. doi: 10.3390/ijms22115783. Int J Mol Sci. 2021. PMID: 34071350 Free PMC article. Review.
-
Mitochondrial approaches to protect against cardiac ischemia and reperfusion injury.Front Physiol. 2011 Apr 12;2:13. doi: 10.3389/fphys.2011.00013. eCollection 2011. Front Physiol. 2011. PMID: 21559063 Free PMC article.
-
Metabolic Therapy in Heart Failure.Card Fail Rev. 2015 Oct;1(2):112-117. doi: 10.15420/cfr.2015.1.2.112. Card Fail Rev. 2015. PMID: 28785443 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
