A number of epidemiological studies have shown that noncoronary factors contribute to heart disease in the diabetic. In addition, recent studies have also shown that the outcome of patients suffering a myocardial infarction is correlated to the degree of metabolic control in the diabetic. One prominent metabolic alteration that occurs in the diabetic is an increase in circulating fatty acid levels and an increased reliance of the heart on fatty acids as an energy substrate. Even in the nondiabetic, elevated fatty acid levels can contribute to the severity of a myocardial infarction. Therefore, alterations in fatty acid metabolism in the myocardium of the diabetic may also contribute to myocardial ischemic injury.