Myocardial Lipid Accumulation in the Diabetic Heart

he 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 contribu- tions to coronary artery disease risk, the metabolic derange- ment of diabetes also can result in abnormalities of cardiac function (diabetic cardiomyopathy) that are likely indepen- dent of effects on the vasculature. Indeed, 3 decades ago, data from the Framingham Heart Study suggested that pa- tients 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.