Targeting Cardiac Metabolic Pathways: A Role in Ischemic Management

Abstract

Among the vast number of noncommunicable diseases encountered worldwide, cardiovascular diseases accounted for about 17.8 million deaths in 2017 and ischemic heart disease (IHD) remains the single-largest cause of death in countries across all income groups. Because conventional medications are not without shortcomings and patients still refractory to these medications, scientific investigation is ongoing to advance the management of IHD, and shows a great promise for better treatment modalities, but additional research can warrant improvement in terms of the quality of life of patients. Metabolic modulation is one promising strategy for the treatment of IHD, because alterations in energy metabolism are involved in progression of the disease. Therefore, the purpose of this review was to strengthen attention toward the use of metabolic modulators and to review the current level of knowledge on cardiac energy metabolic pathways.

Keywords:

• metabolic modulation
• ischemic heart disease
• cardiac energy metabolism
• mitochondrial dynamics

Abbreviations

ADP, adenine diphosphate; ATP, adenine triphosphate; CAD, coronary artery disease; CPT, carnitine palmitoyltransferase; ETC, electron-transport chain; FADH, flavin adenine dinucleotide; FAT, fatty-acid translocase; FATP, fatty acid–binding protein; GIK, glucose insulin potassium; GLUTs glucose transporters; IHD, ischemic heart disease; KAT, ketoacyl thiolase; LDH, lactate dehydrogenase; MCD, malonyl-CoA decarboxylase; NAD, nicotinamide adenine dinucleotide; NADP, nicotinamide adenine dinucleotide phosphate; PDH, pyruvate dehydrogenase; PPAR, peroxisome proliferator–activated receptor; TAG, triacylglycerol; TCA, tricarboxylic acid; VLDL, very-low-density lipoprotein.

Author Contributions

All authors made a significant contribution to the work reported, whether in conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas, took part in drafting, revising, or critically reviewing the article, gave final approval to the version to be published, agreed on the journal to which the article has been submitted, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.