New Approaches to Treating Ischemic Heart Disease, December 11, 2004

New Approaches to Treating Ischemic Heart Disease, December 11, 2004

Ischemic heart disease refers to heart conditions caused by coronary artery ischemia leading to myocardial damage. Beyond the common term “coronary heart disease,” other conditions such as hypotension, aortic valve insufficiency, and anemia can also cause heart disease. Treatment for ischemic heart disease includes three approaches: ① conventional drug therapy; ② interventional therapy; ③ metabolic therapy. Metabolic therapy is a newly emerging approach for treating ischemic heart disease. Conventional drugs, regardless of type, aim to: ① reduce myocardial oxygen consumption; ② increase myocardial oxygen supply—essentially a strategy of cutting costs and increasing revenue. Metabolic therapy, however, focuses on regulating myocardial metabolism, with Wanshuangli as a representative drug. When the myocardium is ischemic, free fatty acid oxidation increases while glucose oxidation and phosphorylation decrease; large amounts of glucose stagnate in the early stages of oxidative metabolism, unable to release ATP, instead accumulating lactic acid and causing myocardial acidosis. On the other hand, free fatty acid oxidation consumes more oxygen than glucose oxidation, simultaneously increasing myocardial oxygen demand and accelerating disease progression. Wanshuangli, however, enhances glucose oxidation in ischemic hearts, reducing myocardial oxygen consumption and lactic acid accumulation, thereby alleviating acidosis. For these reasons, conventional drugs cannot correct the imbalance in free fatty acid and glucose oxidation metabolism, so although they offer some relief, they ultimately prove ineffective for refractory cases. Interventional therapy has a high recurrence rate—about one-quarter in the first year, increasing annually—and despite recent advancements such as drug-eluting stents and improved anticoagulant medications, recurrence remains difficult to prevent or alleviate. Heart transplantation is no easy task due to high costs, donor shortages, and the challenge of overcoming rejection. Therefore, metabolic therapy for ischemic heart disease, with the emergence of Wanshuangli, truly represents a ray of hope in the long night—a bright spot indeed.