The Mystery of Diabetic Cardiomyopathy: From Early Concepts and Underlying Mechanisms to Novel Therapeutic Possibilities

Abstract

Diabetic patients are predisposed to diabetic cardiomyopathy, a specific form of cardiomyopathy which is characterized by the development of myocardial fibrosis, cardiomyocyte hypertrophy, and apoptosis that develops independently of concomitant macrovascular and microvascular diabetic complications. Its pathophysiology is multifactorial and poorly understood and no specific therapeutic guideline has yet been established. Diabetic cardiomyopathy is a challenging diagnosis, made after excluding other potential entities, treated with different pharmacotherapeutic agents targeting various pathophysiological pathways that need yet to be unraveled. It has great clinical importance as diabetes is a disease with pandemic proportions. This review focuses on the potential mechanisms contributing to this entity, diagnostic options, as well as on potential therapeutic interventions taking in consideration their clinical feasibility and limitations in everyday practice. Besides conventional therapies, we discuss novel therapeutic possibilities that have not yet been translated into clinical practice.

Keywords: diabetes mellitus; diabetic cardiomyopathy; heart failure.

Figure 1

Potential mechanisms involved in diabetic cardiomyopathy. AGE, advanced glycation end products; CAD, coronary artery disease; HBP, hexosamine biosynthesis pathway; miRNA, microRNA; O-GlcNAc, O-linked beta-N-acetylglucosamine; RAAS, renin–angiotensin–aldosterone system; ER endoplasmic reticulum.