Metabolic agents in the management of diabetic coronary patients: a new era.

The modulation of cardiac metabolism with Trimetazidine is very important for the control of myocardial ischemia and for the preservation of left ventricular function. The optimization of cardiac metabolism should also include improvement of cardiac insulin resistance with insulin sensitizer agents and the optimization of Kreb's Cycle with essential amino acids. Regarding new drugs that may act inhibiting free fatty acid oxidation we have to underline that to date it is not clear whether Ranolazine has an effect on cardiac metabolism. We agree instead that metabolic agents like Dichloroacetate, Perhexiline and Etomoxir have an antiischemic effect, while their administration requires adjustment of dose and careful monitoring of side effects.