Therapeutic ReviewsMetabolic Modulation: A New Therapeutic Target in Treatment of Heart FailurePalaniswamy, Chandrasekar MD1*; Mellana, William Michael MD1; Selvaraj, Dhana R MD1; Mohan, Diwakar MD2Author Information 1Department of Medicine, New York Medical College, Valhalla, NY; and 2Department of International Health, Johns Hopkins Bloomberg School of Medicine, Baltimore, MD. The authors declare no conflict of interest. *Address for correspondence: New York Medical College, Westchester Medical Center, 95 Grasslands Road PMB 503, Valhalla, NY 10595. E-mail: firstname.lastname@example.org American Journal of Therapeutics: November 2011 - Volume 18 - Issue 6 - p e197-e201 doi: 10.1097/MJT.0b013e3181d70453 Buy Metrics Abstract Treatment of heart failure involves management of risk factors and control of symptoms. Traditional management of heart failure involves the use of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, diuretics, aldosterone antagonists, and digitalis. Metabolic modulators are a newer class of drugs that benefit these patients by modulating cardiac metabolism without altering hemodynamics. They have the potential to relieve symptoms in patients with refractory heart failure who are already on optimal medical therapy. These drugs increase glucose metabolism at the expense of free fatty acid metabolism, thereby enhancing efficient use of oxygen. This review discusses the role of 4 metabolic modulators drugs that could potentially be used for heart failure therapy: trimetazidine, ranolazine, perhexiline, and etomoxir. © 2011 Lippincott Williams & Wilkins, Inc.