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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Article info
Publication history
Published online: January 15, 2018
Accepted:
December 19,
2017
Received:
October 24,
2017
Footnotes
See page 610 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
