MECHANISMS IN ENDOCRINOLOGY: Diabetic cardiomyopathy: pathophysiology and potential metabolic interventions state of the art review.

Eylem Levelt,Gaurav Gulsin,Gerry P Mccann,Stefan Neubauer

doi:10.1530/eje-17-0724

Eylem Levelt, Gaurav Gulsin + Show 2 more

Open Access

https://doi.org/10.1530/eje-17-0724

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Abstract

Heart failure is a major cause of morbidity and mortality in type 2 diabetes. Type 2 diabetes contributes to the development of heart failure through a variety of mechanisms, including disease-specific myocardial structural, functional and metabolic changes. This review will focus on the contemporary contributions of state of the art non-invasive technologies to our understanding of diabetic cardiomyopathy, including data on cardiac disease phenotype, cardiac energy metabolism and energetic deficiency, ectopic and visceral adiposity, diabetic liver disease, metabolic modulation strategies and cardiovascular outcomes with new classes of glucose-lowering therapies.

Highlights

Diabetes has reached epidemic proportions and is among the top 10 causes of death worldwide (1)
The recent use of relatively less load dependent, sensitive measures of myocardial function with strain imaging by echocardiography and Cardiovascular magnetic resonance (CMR) has demonstrated the presence of subtle systolic dysfunction to be frequent as a marker of subclinical heart disease in diabetic patients
In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, PPAR-α agonist fenofibrate treatment was associated with a statistically non-significant trend towards a reduction in the 5-year CVD risk of 14.5 to 13.1%, representing a proportional risk reduction of 11% (adjusted HR 0.89, P = 0.052; absolute risk reduction 1.4%)

Summary

Introduction

Diabetes has reached epidemic proportions and is among the top 10 causes of death worldwide (1). The recent use of relatively less load dependent, sensitive measures of myocardial function with strain imaging by echocardiography and CMR has demonstrated the presence of subtle systolic dysfunction to be frequent as a marker of subclinical heart disease in diabetic patients.

Results

Conclusion