Therapeutic Manipulation of Myocardial Metabolism: JACC State-of-the-Art Review

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31 Scopus citations


The mechanisms responsible for the positive and unexpected cardiovascular effects of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes remain to be defined. It is likely that some of the beneficial cardiac effects of these antidiabetic drugs are mediated, in part, by altered myocardial metabolism. Common cardiometabolic disorders, including the metabolic (insulin resistance) syndrome and type 2 diabetes, are associated with altered substrate utilization and energy transduction by the myocardium, predisposing to the development of heart disease. Thus, the failing heart is characterized by a substrate shift toward glycolysis and ketone oxidation in an attempt to meet the high energetic demand of the constantly contracting heart. This review examines the metabolic pathways and clinical implications of myocardial substrate utilization in the normal heart and in cardiometabolic disorders, and discusses mechanisms by which antidiabetic drugs and metabolic interventions improve cardiac function in the failing heart.

Original languageEnglish (US)
Pages (from-to)2022-2039
Number of pages18
JournalJournal of the American College of Cardiology
Issue number16
StatePublished - Apr 27 2021


  • SGLT2i
  • cardiac function
  • myocardial metabolism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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