Modulation of cardiac energetics as a target in ischemic heart disease

Substantial advances in mechanical and adjunctive pharmacological therapies have reduced the consequences of ischemic heart disease. Despite these advances, cardiovascular disease and its major contributor coronary artery disease continue to accrue substantial morbidity and mortality. Metabolic therapies (ranging from insulin to fatty acid oxidation inhibitors and late sodium channel current inhibitors) represent a novel and immediately clinical relevant class of therapies that can contribute to improving patient outcomes. In the current article, I will discuss the basic biology of cardiac metabolism and the clinical efficacy of agents, some of which have direct clinical applicability. As well as outlining the considerations that may culminate in the effective deployment of these agents in the care of patients, I also consider the likely future directions for metabolic therapy in cardiovascular disease.