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Canadian Journal of Cardiology

Abnormal Myocardial Dietary Fatty Acid Metabolism and Diabetic Cardiomyopathy

  • André C. Carpentier
    Correspondence
    Corresponding author: Dr André C. Carpentier, Division of Endocrinology, Faculty of Medicine, University of Sherbrooke, 3001 12th Ave North, Sherbrooke, Québec J1H 5N4, Canada. Tel.: +1-819-564-5243; fax: +1-819-564-5292.
    Affiliations
    Division of Endocrinology, Department of Medicine, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Published:January 15, 2018DOI:https://doi.org/10.1016/j.cjca.2017.12.029

      Abstract

      Patients with diabetes are at very high risk of hospitalization and death from heart failure. Increased prevalence of coronary heart disease, hypertension, autonomic neuropathy, and kidney failure all play a role in this increased risk. However, cardiac metabolic abnormalities are now recognized to play a role in this increased risk. Increased reliance on fatty acids to produce energy might predispose the diabetic heart to oxidative stress and ischemic damage. Intramyocellular accumulation of toxic lipid metabolites leads to a number of cellular abnormalities that might also contribute to cardiac remodelling and cardiac dysfunction. However, fatty acid availability from circulation and from intracellular lipid droplets to fuel the heart is critical to maintain its function. Fatty acids delivery to the heart is very complex and includes plasma nonesterified fatty acid flux as well as triglyceride-rich lipoprotein-mediated transport. Although many studies have shown a cross-sectional association between enhanced fatty acid delivery to the heart and reduction in left ventricular function in subjects with prediabetes and diabetes, these mechanisms change very rapidly during type 2 diabetes treatment. The present review focuses on the role of fatty acids in cardiac function, with particular emphasis on the possible role of early abnormalities of dietary fatty acid metabolism in the development of diabetic cardiomyopathy.

      Résumé

      Les patients diabétiques sont exposés à un risque plus élevé d’hospitalisation et de décès en raison d’insuffisance cardiaque. L’augmentation de la prévalence de la coronaropathie, de l’hypertension, de la neuropathie autonome et de l’insuffisance rénale participe à cette augmentation du risque. Toutefois, on reconnaît maintenant que les troubles du métabolisme cardiaque jouent un rôle dans cette augmentation du risque. Le recours accru aux acides gras pour produire l’énergie prédisposerait le cœur des diabétiques au stress oxydatif et aux lésions ischémiques. L’accumulation intramyocellulaire de métabolites lipidiques toxiques entraîne plusieurs anomalies cellulaires qui contribueraient également au remodelage cardiaque et á la dysfonction cardiaque. Toutefois, la disponibilité des acides gras provenant de la circulation et des gouttelettes lipidiques intracellulaires pour entretenir le cœur est essentielle pour maintenir son fonctionnement. L’apport accru en acides gras au cœur est très complexe et passe par le débit plasmatique des acides gras non estérifiés et le transport médié par les lipoprotéines riches en triglycérides. Bien que plusieurs études aient démontré une association transversale entre l’apport accru en acides gras au cœur et la réduction de la fonction ventriculaire gauche chez les sujets prédiabétiques et diabétiques, ces mécanismes changent très rapidement au cours du traitement du diabète de type 2. La présente revue porte principalement sur le rôle des acides gras sur la fonction cardiaque, notamment les troubles précoces du métabolisme des acides gras d’origine alimentaire dans le développement de la cardiomyopathie diabétique.
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