Cardiac cell death in early diabetes and its modulation by dietary fatty acids

Diabetes is a significant risk factor for cardiovascular diseases with the majority of these complications being attributed to coronary vascular pathology. However, both in humans and animal models of diabetes, an additional heart muscle specific disease in the absence of any vascular pathology has also been described. Even though diverse mechanisms have been suggested to explain the etiology of this diabetic heart disease, important roles of oxidative stress and cell death have been implicated behind this disorder. Apart from hyperglycemia, cardiac lipid overload is currently believed to be responsible for oxidative stress and cell death in the diabetic heart. Although lipotoxicity is considered a major player in precipitating cardiac cell death, most of the existing work revolves around saturated and monounsaturated fatty acids. Looking at the current western diet with its preponderance of omega-6 polyunsaturated fatty acids (PUFA), more emphasis should be placed on its role in the diabetic heart. In this review, we shall highlight the most intriguing and updated findings of the differential fatty acid classes including omega-6 PUFA and their established/probable roles on diabetic myocardial cell death.