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As knowledge of the mechanisms regulating cardiac energy substrate metabolism increases, and as alterations in energy substrate metabolism attend the above cardiac pathophysiologies, the modulation and optimization of energy substrate metabolism represents a novel and promising area for therapeutic intervention in ischemic heart disease and heart failure.

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In 2012 European Medicines Agency (EMA) finished a review of benefits and risks of trimetazidine and recommended restricting use of trimetazidine-containing medicines just as an additional treatment of angina pectoris in case of inadequate control by or intolerance to first-line antianginal therapies.

Additional research is needed to elucidate the mechanisms underlying the complex interactions between myocardial substrate metabolism and NO.

Following administration of a single dose of oral aprepitant 125 mg on day 1 and 80 mg once daily on days 2 and 3 to patients with mild hepatic impairment (Child-Pugh class 5 to 6), the AUC 0-24h of aprepitant was 11% lower on day 1 and 36% lower on day 3 compared with healthy subjects given the same regimen.

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In summary, ranolazine therapy appears to be cost-effective over a variety of health care systems, likely by reducing angina-related hospitalization and revascularization, and improving quality of life.

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To qualify for the study, patients had to have type 2 diabetes, established coronary artery disease and stable angina with at least one angina episode per week.

This latter effect may increase stroke volume and cardiac output that could translate into benefits in exercise capacity.

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