Karnik Ankur A, Fields Anjali V, Shannon Richard P
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Curr Hypertens Rep. 2007 Dec;9(6):467-73. doi: 10.1007/s11906-007-0086-3.
Diabetes mellitus is well recognized as a potent and prevalent risk factor for accelerated atherosclerosis and ischemic heart disease. However, there is also evidence of cardiac dysfunction in diabetes in the absence of coronary atherosclerosis, termed diabetic cardiomyopathy. Changes in ventricular structure and left ventricular systolic and diastolic dysfunction have all been noted even in patients with well-controlled diabetes and without overt macrovascular complications. Insulin resistance, hyperglycemia, and increased free fatty acid metabolism promote coronary microvascular disease, sympathetic nervous system dysfunction, and ventricular remodeling, and may contribute to the altered cardiac phenotype seen in diabetes. In addition to standard therapy (angiotensin-converting enzyme inhibitors and beta-blockers), diabetic patients with left ventricular dysfunction are likely to benefit from targeted therapies to reduce insulin resistance and modulate substrate use.
糖尿病被公认为是加速动脉粥样硬化和缺血性心脏病的一个强大且普遍的危险因素。然而，也有证据表明，在没有冠状动脉粥样硬化的糖尿病患者中存在心脏功能障碍，即糖尿病性心肌病。即使在血糖控制良好且无明显大血管并发症的患者中，也已注意到心室结构的变化以及左心室收缩和舒张功能障碍。胰岛素抵抗、高血糖和游离脂肪酸代谢增加会促进冠状动脉微血管疾病、交感神经系统功能障碍和心室重塑，并可能导致糖尿病患者出现心脏表型改变。除了标准治疗（血管紧张素转换酶抑制剂和β受体阻滞剂）外，左心室功能障碍的糖尿病患者可能会从降低胰岛素抵抗和调节底物利用的靶向治疗中获益。
