Peroxisome Proliferator Activated Receptor-Alpha (PPARα) and PPAR Gamma Coactivator-1alpha (PGC-1α) Regulation of Cardiac Metabolism in Diabetes

Cardiovascular disease is a leading cause of mortality among patients with diabetes, and heart failure exists even in the absence of coronary disease. Myocardial metabolism is altered in the diabetic heart as a result of changes in substrate availability secondary to insulin resistance. The nuclear receptor peroxisome proliferator activated receptor-alpha (PPAR alpha) and PPAR-gamma coactivator-1alpha (PGC-1 alpha) play important roles in transcriptional regulation of myocardial metabolism and contribute significantly to the changes that occur in the diabetic heart. This review summarizes the role of PPAR alpha and PGC-1 alpha in myocardial metabolism in the normal heart and in the diabetic heart.