Effect of selective 3-ketoacyl coenzyme A thiolase inhibition on glucose metabolism in cardiac patients

It has recently been shown that trimetazidine, a 3-ketoacyl coenzyme A thiolase inhibitor, improves overall glucose metabolism in diabetic patients with left ventricular dysfunction. Forearm glucose and lipid metabolism and forearm release of endothelial vasodilator and vasoconstrictor factors during prolonged partial inhibition of fatty acid oxidation by trimetazidine have recently been evaluated in patients with postischemic left ventricular dysfunction. Trimetazidine significantly improved both insulin-induced forearm oxidation of glucose and release of cyclic guanosine monophosphate, whereas forearm release of endothelin-1 was decreased. Although these findings need further confirmation, the combined beneficial effects of trimetazidine on left ventricular function and glucose metabolism make the use of this drug particularly attractive, especially in those cardiac patients in whom abnormalities of both myocardial and glucose metabolism coexist. Heart Metab. 2006;30:21‐24.