Editorial [Hot Topic:The Metabolic Treatment of Coronary Artery Disease and Heart Failure(Executive Editor: Pericle Di Napoli)]

The theory of metabolic modulation has recently assumed clinical relevance in the treatment of various cardiovascular disease. It is now clear that chronic ischemic heart disease, heart failure and diabetic cardiomyopathy have in common several alterations of cardiac metabolism shifted towards a greater utilization of free fatty acids and a reduced efficiency of the Krebs cycle. Over the past years, several drugs have been proposed to improve cardiac metabolism in patients with ischemic heart disease and more recently in those with heart failure. These drugs consist of long-chain 3-ketoacyl coenzyme A thiolase (LC3- KAT) inhibitors, such as trimetazidine and carnitine palmitoyl transferase (CPT)- I and/or -II inhibitors, such as etomoxir and perhexiline. Trimetazidine is the most investigated drug in this group. The last ESC guidelines on the management of patients with stable angina mention the efficacy of metabolic treatment in improving physical efficiency and decreasing the recurrence of pain. The available data suggest that combined therapy of trimetazidine and hemodynamic drugs is an effective antianginal treatment that reduces the risk of pain recurrence and improve the quality of life. The most recent studies also suggest that trimetazidine might be effective in patients with acute coronary syndromes, non-ischemic cardiomyopathy and heart failure. In this issue of Current Pharmaceutical Design, the rationale for metabolic therapy in ischemic and non-ischemic heart disease and chronic heart failure are carefully reviewed by international experts who have contributed in this area of research. Abozguia et al. [1] discuss the pathophysiological aspects of heart metabolism in ischemia and heart failure. Barsotti et al. [2] report the metabolic changes that occur in patients with diabetes mellitus and the metabolic therapeutic options available. Cesar et al. [3] discuss the effects of metabolic treatment on quality of life and effort angina in patients with chronic coronary artery disease. Tang [4] analyses the effects of metabolic treatment on left ventricle remodeling in patients with heart failure. Fragasso et al. [5] analyse the relevance of metabolic management in diabetic patient and highlight the need of optimization of cardiac metabolism. Thuillier R et al. [6] review the pathophysiological and clinical renal protective effects of metabolic therapy in patients with coronary artery disease and diabetes. Finally, Di Napoli et al. [7] analyze the possible prognostic relevance of the metabolic approach with trimetazidine in patients with chronic heart failure. I wish to thank all the authors for their essential contribution. I expect that this issue may represent a useful help in understanding the clinical relevance of the metabolic therapy in patients with ischemic heart disease and/or heart failure.