DIABETIC CARDIOMYOPATHY - THE SIGNIFICANCE OF CREATINE

Diabetics exhibit a greater incidence of cardiovascular disease than n on-diabetics. The vascular changes that occur are well documented and are thought to promote other clinical manifestations such as cardiomyo pathy. Research has shown that the pathogenic events in the myocyte ma y occur independently of atherosclerotic processes. The atheroscleroti c changes in diabetes involve non-enzymatic glycation of extracellular basement membrane proteins. We hypothesize that intracellular glycati on events occur in cardiac tissue that alter intermediary metabolism, particularly Ca2+ homeostasis, which leads to cell dysfunction. Additi onally, we hypothesize that the high steady state intracellular concen trations of unphosphorylated creatine may offer protection against the formation of advanced glycation endproducts by reacting directly with glucose metabolites that may have reached toxic levels in the myocyte of diabetics.