Regulation of myocardial carbohydrate metabolism under normal and ischaemic conditions. Potential for pharmacological interventions

William C. Stanley, Gary D. Lopaschuk, Jennifer L. Hall, James G. McCormack

Research output: Contribution to journalReview articlepeer-review

545 Scopus citations


It is now clear that the availability of different metabolic substrates can have a profound influence on the extent of damage incurred during episodes of cardiac ischaemia, and on cardiac functional recovery on reperfusion following ischaemia. In particular, increases in fatty acid availability and oxidation, compared to glucose oxidation, under such conditions leads to a worsening of outcome. Therefore metabolic interventions aimed at enhancing glucose utilisation and pyruvate oxidation at the expense of fatty acid oxidation is a valid therapeutic approach to the treatment of myocardial ischaemia. In particular, the development of agents which will promote full glucose oxidation as opposed to glycolysis alone, offer clear advantages. This can be accomplished by different means, including direct or indirect inhibition of CPT-I or inhibition of fatty acid β-oxidation, or by direct or indirect activation of PDH. It is not yet clear which of these approaches offers the best treatment of cardiac ischaemia. To date, trimetazidine and carnitine have received limited approval in Europe for the treatment of angina; large scale clinical trials with the other agents mentioned above have not been completed. The increasing availability of agents affecting these specific sites, and the increasingly sophisticated techniques for assessing myocardial metabolism, should allow elucidation of the optimum metabolic targets and development of novel pharmacological agents for the treatment of ischaemic heart disease.

Original languageEnglish (US)
Pages (from-to)243-257
Number of pages15
JournalCardiovascular Research
Issue number2
StatePublished - Feb 1997

Bibliographical note

Copyright 2007 Elsevier B.V., All rights reserved.


  • cardiac metabolism
  • carnitine
  • fatty acids
  • glycolysis
  • heart
  • insulin
  • lactate
  • myocardial ischemia
  • pyruvate dehydrogenase
  • reperfusion


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