Summary
These studies argue convincingly that the extracellular matrix, in particular collagen, is a dynamic component of the heart. Collagen deposition and removal are remarkably complex processes but this complexity provides many possible targets for pharmacological intervention. Many compounds, some in current therapeutic use especially in patients with hypertension, diabetes, and heart failure, have been shown to alter collagen content. While other compounds are unlikely to become therapeutic tools, they are allowing an investigation into possible mechanisms for the prevention or reversal of fibrosis. More importantly, these studies have shown us that controlling cardiac collagen is not simply a biochemical curiosity since many studies have now shown improvements in the functioning of the diseased heart. While most of these studies are in rodent models of human cardiovascular disease, those studies on humans are also positive. Research into cardiac collagen is still gaining momentum with almost all the studies cited in this review having been published in the last 10 years and many in the last 2-3 years. Thus, pharmacological control of collagen in the heart is likely to become a standard and successful component of the therapy of human cardiovascular disease.