High Blood Pressure Induces Low Fat Metabolism in Heart Muscle

"The heart is the single most energy-consuming organ per weight in the body," says Lisa de las Fuentes, M.D.

Under some conditions this energy-hungry organ is prone to defects in its energy metabolism that contribute to heart disease, according to research published in a recent issue of the Journal of Nuclear Cardiology by de las Fuentes and colleagues at Washington University School of Medicine in St. Louis.

Earlier research led by de las Fuentes' colleague Robert J. Gropler, M.D., showed that heart muscle in people with diabetes is overly dependent on fat for energy. Even though fat is an efficient fuel, burning it for energy creates an unusually high demand for oxygen, making the diabetic heart more sensitive to the drops in oxygen levels that occur with coronary artery blockage.

Gropler is director of the Cardiovascular Imaging Laboratory at the Mallinckrodt Institute of Radiology at the School of Medicine and professor of radiology, medicine and biomedical engineering.

Now this group of Washington University researchers has shown that hearts of non-diabetics with muscle thickening due to high blood pressure have an energy metabolism skewed in the opposite direction - away from the use of fat for energy.

"Whereas Dr. Gropler found that a high level of fatty acid metabolism could be detrimental, we show that a low level may also be harmful," says de las Fuentes, co-director of the Cardiovascular Imaging and Clinical Research Core Laboratory and assistant professor of medicine. "These findings aren't contradictory. The heart has to be able to choose the energy source, either fats or glucose, most appropriate for its current energy needs and the availability of fuel."

De las Fuentes explains that hearts with muscle thickening, or hypertrophy, get less energy because of their reduced fat metabolism, which leads them to rely more heavily on carbohydrates.

"Carbohydrates produce less energy per molecule than fatty acids," she says. "With hypertrophy, the heart has a higher energy demand because there's more muscle to feed. With less fat metabolism, a greater reliance on carbohydrates may represent a shift to a less-efficient fuel."

The metabolic abnormality can eventually lead to impaired contraction of the heart and to heart failure.

Animal studies by collaborators at Washington University have shown that in mice with thickened heart muscle, genes associated with transporting and breaking down fatty acids are less active than normal - in other words, the heart's fat-burning machinery is malfunctioning.

In this human study, the researchers studied patients who had high blood pressure that resulted in hypertrophy of the muscle of the left ventricle, the chamber of the heart that pumps blood to the body. The study showed that the greater the muscle mass of the hypertrophic heart, the lower the ability to burn fat. Magnetic resonance scans suggested that hypertrophic heart muscle had subtle abnormalities in contractile function at rest and was less energy efficient.