The Diabetic Cardiomyopathy: The Contributing Pathophysiological Mechanisms
Open accessAbstract
Individuals with diabetes mellitus (DM) disclose a higher incidence and a poorer prognosis of heart failure (HF) than non-diabetic people, even in the absence of other HF risk factors. The adverse impact of diabetes on HF likely reflects an underlying "diabetic cardiomyopathy" (DM-CMP), which may by exacerbated by left ventricular hypertrophy and coronary artery disease (CAD). The pathogenesis of DM-CMP has been a hot topic of research since its first description and is still under active investigation, as a complex interplay among multiple mechanisms may play a role at systemic, myocardial, and cellular/molecular levels. Among these, metabolic abnormalities such as lipotoxicity and glucotoxicity, mitochondrial damage and dysfunction, oxidative stress, abnormal calcium signaling, inflammation, epigenetic factors, and others. These disturbances predispose the diabetic heart to extracellular remodeling and hypertrophy, thus leading to left ventricular diastolic and systolic dysfunction. This Review aims to outline the major pathophysiological changes and the underlying mechanisms leading to myocardial remodeling and cardiac functional derangement in DM-CMP.
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Several pathophysiological mechanisms associated with diabetes may contribute to diabetic cardiomyopathy: oxidative stress, inflammation, impaired mitochondrial energetics, altered intracellular calcium handling, and increased neuro-humoral activation, determining myocardial inflammation, hypertrophy, fibrosis, and coronary microvascular disease.
“Several pathophysiological mechanisms associated with diabetes may contribute to this entity, namely oxidative stress, inflammation, impaired mitochondrial energetics, altered intracellular calcium handling, and increased neuro-humoral activation, that all together determine myocardial inflammation, hypertrophy, fibrosis, and coronary microvascular disease [64].”
From Dysregulated epicardial adipose tissue as a risk factor and potential therapeutic target of heart failure with preserved ejection fraction in diabetes (2022) · cites this paper as [64]
Diabetic individuals are predisposed to a distinct cardiomyopathy, named diabetic cardiomyopathy, characterized by abnormalities of myocardial structure and performance in the absence of other cardiac risk factors.
“Both experimental and clinical evidence state that diabetic individuals are predisposed to a distinct cardiomyopathy, named diabetic cardiomyopathy, a heart muscle-specific disease characterized by abnormalities of myocardial structure and performance in the absence of other cardiac risk factors, such as CAD, hypertension, and significant valvular disease.”
From Dysregulated epicardial adipose tissue as a risk factor and potential therapeutic target of heart failure with preserved ejection fraction in diabetes (2022) · cites this paper as [64]
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References 295 · Cited by 165
Research works printed but not linked: 1
- [285]Packer M Butler J Filippatos GS Jamal W Salsali A Schnee J. Evaluation of the effect of sodium-glucose co-transporter 2 inhibition with empagliflozin on morbidity and mortality of patients with chronic heart failure and a reduced ejection fraction: rationale for and design of the EMPEROR-reduced trial. Eur J Heart Fail. (2019) 21: 1270– 8. 10.1002/ejhf.1536 31584231 · DOI
- Authors
- Salvatore, T., Pafundi, P. C., Galiero, R., Albanese, G., Di Martino, A., Caturano, A., Vetrano, E., Rinaldi, L., & Sasso, F. C.
- Affiliations
- University of Campania "Luigi Vanvitelli" (IT)
- Corresponding author
- Sasso, Ferdinando Carlo
- ORCID
- Venue
- Frontiers in Medicine
- Publisher
- Frontiers Media SA
- Published
- 2021-06-30
- Volume
- 8
- Pages
- 695792-695792
- ISSN
- 2296-858X (ISSN-L)
- PMC
- PMC8279779
- OpenAlex
- W3177017985
- Cited by
- 165
- References
- 295
- Citations by year
- 2026: 25 · 2025: 40 · 2024: 41 · 2023: 23 · 2022: 28 · 2021: 8
- FWCI
- 4.88
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi del Molise (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Keywords
- diabetic cardiomyopathy, diabetes mellitus, heart failure, left ventricular hypertrophy, coronary artery disease, lipotoxicity, glucotoxicity, mitochondrial dysfunction, oxidative stress, calcium signaling, inflammation, epigenetics, cardiac remodeling, diastolic dysfunction, systolic dysfunction
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