NAD⁺ the disregarded molecule in cardiac metabolism

Extract

Introduction

Advanced age and cardiovascular diseases are related to alterations in cellular metabolism.^1,2 The accumulation of fat, a phenomenon observed in ageing, causes a disturbance in glucose and lipid metabolism altering cardiovascular health.^3,4

Current therapeutic approaches focus on the treatment of ‘classic’ risk factors such as arterial hypertension, diabetes mellitus, and hyperlipidaemia. It is believed that at least 90% of cardiovascular diseases could be preventable, if the right targets for prevention can be identified.⁵ Numerous studies are suggesting that it is possible to delay the ageing process by manipulating cellular metabolism and thus reverse or delay age-associated diseases including cardiovascular diseases.^2,6,7 Experimental drugs that can interfere with myocardial metabolism have been tested experimentally and in clinical trials.^8–10 Most of them aim at switching the energy substrate of the myocardium in oxygen (O₂) restricted diseases to optimize O₂ consumption at the expense of optimized energy production. Although some of these therapies showed promising results, the side effects of switching energy substrates can be detrimental to the myocardium.^9,11,12 Clearly, a better understanding of the metabolic processes and their role and interactions with the development of cardiovascular diseases is needed.