Abstract
The prevalence of cardiac diabetic diseases has been increased around the world, being the most common cause of death and disability among diabetic patients. In particular, diabetic cardiomyopathy is characterized with a diastolic dysfunction and cardiac remodelling without signs of hypertension and coronary artery diseases. In an early stage, it is an asymptomatic disease; however, clinical studies demonstrate that diabetic myocardia are more vulnerable to injury derived by acute myocardial infarct and are the worst prognosis for rehabilitation. Currently, biochemical and imaging diagnostic methods are unable to detect subclinical manifestation of the disease (prior to diastolic dysfunction). In this review, we elaborately discuss the current scientific evidences to propose circulating microRNAs as promising biomarkers for early detection of diabetic cardiomyopathy and, then, to identify patients at high risk of diabetic cardiomyopathy development. Moreover, here we summarise the research strategies to identify miRNAs as potential biomarkers, present limitations, challenges, and future perspectives.
Highlights
The global prevalence of diabetes was estimated as 387 million people in 2014 and expected to increase to 592 million by 2035
Population-based cohort studies reported by From et al suggested that patients with heart failure and diabetes but no atherosclerosis had a higher risk of death [5]
Changes in gene expression of key molecules involved in the pathogenesis of diabetic cardiomyopathy can be influenced by environmental factors, for instance, high fat diets, tobacco smoke, or epigenetic factors [22]
Summary
The global prevalence of diabetes was estimated as 387 million people in 2014 and expected to increase to 592 million by 2035. While atherosclerosis is well known to increase the risk of heart failure through an episode of ischemia, the weakening of the cardiac fibres by the silent progression of diabetic cardiomyopathy is not accounted due to technical limitations in its subclinical detection. In spite of the differences in etiology and metabolic profile, many pathophysiologic features of this cardiomyopathy are shared by diabetes mellitus type 1 (DMT1) and diabetes mellitus type 2 (DMT2) [8] Considering these common pathophysiological mechanisms, in a prediabetic and diabetic state, plasma level of free fatty acid (FFA) is increased, producing an augmented uptake, accumulation, and oxidation of FFA in the cardiomyocytes. We summarize the scientific evidences to propose miRNAs as new generation of biomarkers at subclinical stages of this disease by reflexing in biofluids the myocardial metabolic derangement before cardiac dysfunction
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