Abstract
In type 2 diabetes mellitus (T2DM), there is an increased prevalence of cardiovascular disease (CVD), even when corrected for atherosclerosis and other CVD risk factors. Diastolic dysfunction is one of the early changes in cardiac function that precedes the onset of cardiac failure, and it occurs already in the prediabetic state. It is clear that these changes are closely linked to alterations in cardiac metabolism; however, the exact etiology is unknown. In this narrative review, we provide an overview of the early cardiac changes in fatty acid and glucose metabolism in prediabetes and its consequences on cardiac function. A better understanding of the relationship between metabolism, mitochondrial function, and cardiac function will lead to insights into the etiology of the declined cardiac function in prediabetes.
Highlights
Prediabetes, defined as impaired fasting glucose or impaired glucose tolerance (2-h plasma glucose between 7.8 and11.0 mmol/L) [1], places individuals at high risk of developing type 2 diabetes mellitus (T2DM) and its cardiovascular disease (CVD)-related complications [2,3]
The increased risk of CVD is proportional to the fasting blood glucose in prediabetes [2,4,5] and is mainly caused by atherosclerosis, induced by the many risk factors that are characteristic for prediabetic patients, for instance, dyslipidemia and hypertension [6,7,8,9,10,11,12]
Even when corrected for atherosclerosis, cholesterol values, bodyweight, blood pressure, and age, patients with prediabetes remain at increased risk for the development of heart failure, mainly through the development of diastolic dysfunction (in T2DM known as diabetic cardiomyopathy (DCM)) [14,15]
Summary
Prediabetes, defined as impaired fasting glucose (fasting plasma glucose between. 6.1 and 6.9 mmol/L) or impaired glucose tolerance Even when corrected for atherosclerosis, cholesterol values, bodyweight, blood pressure, and age, patients with prediabetes remain at increased risk for the development of heart failure, mainly through the development of diastolic dysfunction (in T2DM known as diabetic cardiomyopathy (DCM)) [14,15]. DCM [18,19], and this may already be at play in prediabetes Recognition of these metabolic changes may help to better understand the underlying etiology of diastolic dysfunction in prediabetes, which provides a window of opportunity for the prevention of DCM in the early development of T2DM.
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