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Additionally, as the first CVD to develop in patients with diabetes is often heart failure rather than myocardial infarction [1], it is becoming clear that the pathology of diabetes itself causes heart failure through direct effects on cardiomyocytes and other myocardial cell types

and Wartiovaara, A

In addition, levocarnitine buffers excess intramitochondrial acyl-CoA, regenerating free coenzyme A and potentially preventing inhibition of critical metabolic enzymes