Cardiac insulin-resistance and decreased mitochondrial energy production precede the development of systolic heart failure after pressure-overload hypertrophy. http://www.ncbi.nlm.nih.gov/pubmed/23861485 CONCLUSIONS: The development of cardiac insulin-resistance and decreased mitochondrial oxidative metabolism are early metabolic changes in the development of cardiac hypertrophy, which create an energy deficit that may contribute to the progression from hypertrophy to heart failure. Stimulation of glucose oxidation protects against acute myocardial infarction and reperfusion injury http://cardiovascres.oxfordjournals.org/content/94/2/359.long 1. Introduction Ischaemic heart disease is a major health problem worldwide, affecting North Americans more adversely than any other pathological condition. Although numerous mechanisms contribute to ischaemic injury,1 there is clear evidence that cardiac dysfunction during and following myocardial ischaemia is mediated, at least in part, by the type of energy substrate utilized by the heart.2–5 For example, following ischaemia and during reperfusion, an excessive reliance on fatty acids contributes to cardiac dysfunction.2,6 Elevated fatty acid oxidation rates result in the subsequent inhibition of glucose oxidation rates in the heart.2,7 Furthermore, glycolytic rates remain high and are thus uncoupled from glucose oxidation, thereby increasing proton production and decreasing cardiac efficiency.2,8,9 We and others have demonstrated that overcoming fatty acid oxidation-induced inhibition of glucose oxidation in the heart (either by directly stimulating glucose oxidation,2,8,10 or by inhibiting fatty acid oxidation),11–13 improves the recovery of post-ischaemic cardiac function. Conclusion These findings demonstrate that stimulating glucose oxidation via targeting either PDH or MCD decreases the infarct size, validating the concept that optimizing myocardial metabolism is a novel therapy for ischaemic heart disease. Targeting fatty acid and carbohydrate oxidation — A novel therapeutic intervention in the ischemic and failing heart http://www.sciencedirect.com/science/article/pii/S0167488911000231 Research highlights ► Fatty acid and carbohydrate oxidation provide ATP required for cardiac contraction. ► Balance between fatty acid and carbohydrate oxidation affects cardiac efficiency/function. ► Fatty acid oxidation predominates in the post-ischemic and failing heart. ► Interventions can increase carbohydrate oxidation and decrease fatty acid oxidation. ► Increasing carbohydrate oxidation benefits the post-ischemic and failing heart. 1. Introduction The high energy requirements of the myocardium are evidenced by the high rates of adenosine triphosphate (ATP) synthesis and hydrolysis. Myocardial ATP stores are relatively low compared to the amount of ATP required to sustain cardiac contraction, basal metabolism, and ionic homeostasis. As a result, there is a nearly complete turnover of the myocardial ATP pool every 10 s [1], with the heart cycling approximately 6 kg of ATP on a daily basis [2]. To meet these high energy demands, the normal heart possesses a high degree of metabolic flexibility, which is demonstrated by its ability to utilize various energy substrates including fatty acids, glucose, lactate, and ketone bodies to generate ATP. The contribution of each of these energy substrates to ATP generation is tightly regulated, and there is a significant degree of plasticity and interdependence between energy substrates utilized. http://www.sciencedirect.com/science/article/pii/S0167488911000231