Diabetes and ischemia: similarities in cardiac energy metabolism

Ischemic heart disease (IHD) and diabetes mellitus (DM) are leading causes of death worldwide. Cardiac energy metabolism is profoundly altered in both of these conditions, which can lead to permanent cardiac pathologies that include heart failure and diabetic cardiomyopathy. Diabetic hearts show an increased dependence on oxidation of fatty acids for the production of adenosine triphosphate (ATP) accompanied by an impairment of glucose oxidation. Such features resemble to a large extent the metabolic phenotype of the ischemic heart during ischemia and reperfusion. Likewise, ischemic myocardium displays the insulin insensitivity that typically exists in the diabetic heart. Other common features include reduced circulating levels of adiponectin, a cardioprotective adipokine, and an enhanced state of acetylation of specific lysine residues in enzymes and transcription factors that are essential in energy metabolic processes. Recognizing cardiac metabolism similarities between DM and IHD should help to devise and optimize metabolic modulatory therapies for comorbidity patients. L Heart Metab. 2015;68:4-8