Pathogenesis, Clinical Features and Treatment of Diabetic Cardiomyopathy

Abstract

Patients with type 1 and type 2 diabetes mellitus (T1D and T2D) show an increased incidence of heart failure (HF) even after adjustment for well established risk factors for HF such as hypertension and ischaemic heart disease. The resulting specific form of cardiomyopathy is known as diabetic cardiomyopathy" (DCM). Pathogenetic mechanisms underlying DCM are likely to be multifactorial, from altered myocardial metabolism (hyperglycaemia, hyperinsulinaemia, increased circulating fatty acids and trglycerides) to microvascular disease, autonomic neuropathy, and altered myocardial structure with fibrosis. Current medical treatment recommendations from scientific societies on HF in patients with diabetes mellitus (DM) do not differ from those for patients without DM. Regarding the effect of different hypoglycaemic drugs on HF in patients with DM, and considering the best available current evidence, the sodium-glucose-co-transporter 2 inhibitors and metformin seem to be especially advantageous regarding the effects in patients with T2D and HF.

Keywords: Cardiac lipotoxicity; Diabetes mellitus; Diabetic cardiomyopathy; Diastolic dysfunction; Heart failure; Left ventricular ejection fraction; Systolic dysfunction.