Diabetic cardiomyopathy: current state of the problem. Review

Abstract

The literature review describes the evolution of views on diabetic cardiomyopathy (DCM): from a pathological condition with myocardial hypertrophy and fibrosis in patients with diabetes mellitus (DM) to the development of heart failure (HF) in the absence of other cardiovascular diseases (CVD). It has been demonstrated that DCM is a staged pathophysiological condition inherent in patients with DM and impaired glucose tolerance, caused by hyperglycemia, hyperinsulinemia, and insulin resistance, characterized by molecular changes, remodeling of the left chambers of the heart, a decrease in the systolic‑diastolic reserve of the ventricular myocardium, the development of HF, and is associated with dysfunction of the autonomic nervous system, disruption of energy metabolism and increased inflammation. The features of heart damage in both type 1 and type 2 DM were analyzed, and the importance of glycemic control to prevent the development and progression of HF was noted. The results of experimental and clinical studies (CARVAR 92 cohort, LIFE, RENAAL, the Framingham study, HyperGEN, the Strong Heart Study, RECORD trial, PRO active Study) gave the ground to claim that secondary DM prevention reduces the risks of death from CVD and the progression of pump function deterioration of the heart. Screening of DCM biomarkers (long non‑coding RNA and galectin‑3) and carrying out of Doppler echocardiography in patients with DM and impaired glucose tolerance will allow timely and adequate initiation of DCM treatment. Ways to correct changes in the heart that develop in patients with DM are given. Metformin, empagliflozin, canagliflozin, liraglutide, and semaglutide are listed as promising medications for drug correction of DCM.