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What is Metabolic Cardiology?

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

Metabolic cardiology is a new field of medicine which concentrates on the prevention, management, and treatment of cardiovascular disease at the cellular level, through biochemical interventions that are native to the human body. Diseased hearts are energy-starved, which means they lack enough adenosine triphosphate (ATP) to fuel healthy cardiac function. ATP molecules are both synthesized and recycled within the body, and supply all of the body’s energy. Metabolic cardiology aims to build up and maintain ATP stores in the heart, and ultimately enhance heart health, by providing the body with the nutrients it needs to make ATP.

Coenzyme Q10 (CoQ10), L-carnitine, D-ribose, and magnesium, the staples of metabolic cardiology, are nutrients essential for ATP production. I call these nutrients, “the awesome foursome.” While the body requires D-ribose to synthesize ATP de novo, or from scratch, it utilizes carnitine and CoQ10 to efficiently recycle ATP. Magnesium, which participates in over 300 enzymatic reactions in the body, also helps boost ATP production to prevent and treat cardiovascular disease.

In Metabolic Cardiology: It’s all about ATP part 2, Dr. Richard Passwater, Ph.D, author of several books on nutrition, interviews me about the roles ATP and its precursors, CoQ10, D-ribose, and the carnitines, play in heart health. In an earlier interview with Dr. Passwater, Co-enzyme Q10 and Heart Health, I explain how and why I started treating patients with CoQ10 in the 1980s.

You can read more about metabolic cardiology in my book, The Sinatra Solution: Metabolic Cardiology or in my recent peer-reviewed articles, Metabolic Cardiology: The Missing Link in Cardiovascular Disease and Metabolic Cardiology: An Integrative Strategy in the Treatment of Congestive Heart Failure.

I believe that metabolic cardiology provides an enormous source of hope for patients with any form of cardiovascular disease. In my clinical experience, metabolic cardiology has proven to reduce human suffering while often supporting longevity.

© 2012 HeartMD Institute. All rights reserved.

Leave a Reply


  1. Heidi

    on August 5, 2013 at 8:33 pm

    My husband has AF. Does your site cover this? He is lean and fit, but suffers also from central, mixed and obstructive apnoea. Is there any articles on this growing epidemic? Many thanks, Heidi

  2. Carina

    on July 15, 2016 at 12:35 am

    my cardiologist says my heart failure isn’t from a floppy heart muscle, but mine is stiff. and I have severe pulmonary hypertension. will this help me too?

  3. Sandy

    on November 9, 2018 at 9:59 am

    Any recommendations for palpitations? Thank you!

  4. Linda Drake

    on January 5, 2019 at 5:32 pm

    Is there a way to find a metabolic cardiologist in my area? I live in Lancaster, PA. Thanks!

  5. Jerry

    on February 7, 2019 at 12:33 am

    I was hospitalized with AFib in December 2017. My EF was 25;it later went up to 37. A recent resting stress test had it at 33. I recently read Dr. Sinatra’s book and starting taking CQ10,D-Ribose, Magnesium, and L-Carnitine. I feel better,but it hasn’t yet affected my Heart Function.
    I have also been on Testosterone replacement Therapy and take a 1 ml injection once a week Could this have an effect on the Heart Function. Also, what effect would drinking wine have on this problem. I am 70 and exercise daily.

  6. Wendy van den Brink-Poncin

    on February 19, 2019 at 11:16 am

    Thank you very much for these insights.
    Can you recommend any cardiologist in the Netherlands who treats his patients with metabolic cardiology?
    Hope to receive a reply. Thank you.

  7. Gerald

    on February 25, 2019 at 10:46 am

    Do you have any recommended Metabolic Cardiologists in the new Jersey/New York area?

  8. sergio paulo

    on March 7, 2019 at 9:55 pm

    I had two infarctions … a recent 30 days … I’m only taking ubiquinol 200mg in 2x day, propionyl l card 500mg 2x day, magnesium 500mg 2x day, ed ribose 10gr 2x day tome hawthorn berries 500mg 2x day, natokinase 100mg 3x day, I also take ARJUNA cardioComfort, garlic, onion, ginger, 4x week hiking
      diagnosis of the last echo. various functions of the heart with discrete degree and left ventricular diastolic dysfunction grade II.
    that’s right? only this will prevent another heart attack?

  9. Amy Winters

    on May 17, 2019 at 8:07 pm

    I recently had to visit the cardiology office due to chest pains. As I was reading your article, you write about how metabolic cardiology will help treat cardiovascular disease at the cellular level. I’m so glad there are professionals out there still educating themselves on human anatomy.

  10. Anthony Verderese

    on March 17, 2021 at 6:50 pm

    Where can I find a metabolic cardiologist in south Jersey.

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