Myocardial lipid accumulation in the diabetic heart.

The prevalence of type 2 diabetes mellitus is rising in the United States, with a recent estimate suggesting that 7% of the US population (or 21 million persons) have the disease.1 In addition to well-recognized contributions to coronary artery disease risk, the metabolic derangement of diabetes also can result in abnormalities of cardiac function (diabetic cardiomyopathy) that are likely independent of effects on the vasculature. Indeed, 3 decades ago, data from the Framingham Heart Study suggested that patients with type 2 diabetes mellitus have an increased risk of congestive heart failure that persists when adjusted for atherosclerotic disease.2 Although clinical appreciation of diabetic cardiomyopathy has since increased significantly, the mechanisms by which diabetes mellitus causes diastolic and systolic dysfunction in patients without epicardial coronary artery disease remain unclear.