Diabetic cardiomyopathy: a metabolic perspective.

Patients with diabetes mellitus have a >3-fold increased risk of coronary ischemic events and congestive heart failure. Several hypotheses have been provided to explain the increased cardiac vulnerability in individuals with diabetes; among these are the metabolic abnormalities. Diabetes is associated with profound changes in cardiac metabolism, characterized by diminished glucose utilization, diminished rates of lactate oxidation, and increased use of fatty acids. Very few investigations have focused on amino acid disturbances at the level of the heart. This area of research is potentially relevant because cardiac amino acid alterations may not only result in a reduced energy reserve but could also lead to quantitative and qualitative abnormalities of contractile protein present in the diabetic heart.