TITLE:
Diabetic Cardiovascular Risk and Carnitine Deficiency —Carnitine Deficiency in Clinical Diabetes Mellitus
AUTHORS:
John I. Malone, Michael A. Malone, Anthony D. Morrison
KEYWORDS:
Type 1 Diabetes Mellitus, Cardiovascular Disease, Heart Failure, Reduced ATP, Carnitine Deficiency
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.4 No.3,
August
6,
2014
ABSTRACT:
Background: Type 1
diabetes mellitus increases the risk of coronary heart disease. The Pittsburgh
IDDM morbidity and mortality study reported greater than 10 fold coronary heart
disease mortality compared with US national data[1]. Adults with diabetes have heart
disease death rates 2 to 4 times higher than adults without diabetes [2]. Diabetic cardiomyopathy explains
much of this survival difference and carnitine deficiency is a cause of
cardiomyopathy. Research Design and Methods: Adult subjects (40) with type 1
diabetes mellitus were seen for a routine annual visit having no clinical
complaints. Fasting serum samples were collected for annual chemistries and the
measurement of carnitine. Results: The mean total (40.8 ± 8.8) [40 - 80 nmol/ml] and free (32.9 ± 7.9) [30 -
60 nmol/ml] carnitine levels for this group included 43% low total and 28% low
free carnitine. The mean esterified/free (E/F) carnitine ratio (0.25 ± 0.09)
for this group was elevated indicating carnitine insufficiency. Conclusions:
Fatty acids are the primary energy source for diabetic heart muscle, and
carnitine is essential for intracellular fatty acid transport and ATP
production. Therefore, mild carnitine deficiency can compromise fatty acid
energy production in a failing heart. Carnitine deficiency in subjects at high
risk for cardiovascular failure is a possible unrecognized reason for the 4
fold increased death rate in patients with type 1 diabetes. Supplementation
with oral carnitine could reduce that increased risk of heart failure, in
patients with type 1 diabetes. Intravenous carnitine may be life saving when
managing acute cardiac failure in patients with diabetes mellitus. Normal
carnitine levels in patients with type 1 diabetes may provide a biochemical
environment that prevents the long recognized idiopathic heart failure that occurs in insulin
requiring diabetics as first reported in the 1974 Framingham Study.