Medium-chain fatty acids as metabolic therapy in cardiac disease

Introduction Medium-chain fatty acids (MCFAs) have physical and metabolic properties that are distinct from those of long-chain fatty acids, which make them a readily available cellular energy source. These properties have been used advantageously in the clinics for more than 50 years for treating lipid absorption disorders, undernourished patients, and more recently subjects with long-chain fatty acid oxidation defects. In these latter subjects, nutritional interventions with MCFA-containing triglycerides have been shown to improve clinical symptoms, particularly cardiomyopathies. Potential benefits of MCFA metabolism in cardiac diseases There is, however, only a limited number of studies that have considered the potential use of MCFAs as metabolic therapy for cardiac diseases in general. Nevertheless, current experimental evidence does support the notion that the diseased heart is energy deficient and that alterations in myocardial energy substrate metabolism contribute to contractile dysfunction and cardiac disease development and progression. Hence, this article will review current literature on MCFAs with a specific emphasis on their metabolism and potential benefits for the heart. It will include practical considerations about the potential clinical application of MCFA therapy for the management of patients with cardiac diseases.