Journal article : Review
Redefining diabetic cardiomyopathy: perturbations in substrate metabolism at the heart of its pathology
- Abstract:
- Cardiovascular disease represents the leading cause of death in people with diabetes, most notably from macrovascular diseases such as myocardial infarction or heart failure. Diabetes also increases the risk of a specific form of cardiomyopathy, referred to as diabetic cardiomyopathy (DbCM), originally defined as ventricular dysfunction in the absence of underlying coronary artery disease and/or hypertension. Herein, we provide an overview on the key mediators of DbCM, with an emphasis on the role for perturbations in cardiac substrate metabolism. We discuss key mechanisms regulating metabolic dysfunction in DbCM, with additional focus on the role of metabolites as signaling molecules within the diabetic heart. Furthermore, we discuss the preclinical approaches to target these perturbations to alleviate DbCM. With several advancements in our understanding, we propose the following as a new definition for, or approach to classify, DbCM: “diastolic dysfunction in the presence of altered myocardial metabolism in a person with diabetes but absence of other known causes of cardiomyopathy and/or hypertension.” However, we recognize that no definition can fully explain the complexity of why some individuals with DbCM exhibit diastolic dysfunction, whereas others develop systolic dysfunction. Due to DbCM sharing pathological features with heart failure with preserved ejection fraction (HFpEF), the latter of which is more prevalent in the population with diabetes, it is imperative to determine whether effective management of DbCM decreases HFpEF prevalence.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
-
-
(Preview, Accepted manuscript, pdf, 1.0MB, Terms of use)
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- Publisher copy:
- 10.2337/dbi23-0019
Authors
+ British Heart Foundation
More from this funder
- Funder identifier:
- https://ror.org/02wdwnk04
- Grant:
- FS/17/58/33072
+ Canadian Institutes of Health Research
More from this funder
- Funder identifier:
- https://ror.org/01gavpb45
- Grant:
- PJT-159648
- Publisher:
- American Diabetes Association
- Journal:
- Diabetes More from this journal
- Volume:
- 73
- Issue:
- 5
- Pages:
- 659-670
- Place of publication:
- United States
- Publication date:
- 2024-02-22
- Acceptance date:
- 2024-02-15
- DOI:
- EISSN:
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1939-327X
- ISSN:
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0012-1797
- Pmid:
-
38387045
- Language:
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English
- Keywords:
- Subtype:
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Review
- Pubs id:
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1691881
- Local pid:
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pubs:1691881
- Deposit date:
-
2025-06-11
Terms of use
- Copyright holder:
- American Diabetes Association
- Copyright date:
- 2024
- Rights statement:
- © 2024 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
- Notes:
- This is the accepted manuscript version of the article. The final version is available online from American Diabetes Association at https://dx.doi.org/10.2337/dbi23-0019
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