Fuentes-Antrás Jesús, Picatoste Belén, Ramírez Elisa, Egido Jesús, Tuñón José, Lorenzo Óscar
Cardiovasc Diabetol. 2015 Feb 7;14:17. doi: 10.1186/s12933-015-0173-8.
Diabetic cardiomyopathy is defined as ventricular dysfunction initiated by alterations in cardiac energy substrates in the absence of coronary artery disease and hypertension. In addition to the demonstrated burden of cardiovascular events associated with diabetes, diabetic cardiomyopathy partly explains why diabetic patients are subject to a greater risk of heart failure and a worse outcome after myocardial ischemia. The raising prevalence and accumulating costs of cardiovascular disease in diabetic patients underscore the deficiencies of tertiary prevention and call for a shift in medical treatment. It is becoming increasingly clearer that the effective prevention and treatment of diabetic cardiomyopathy require measures to regulate the metabolic derangement occurring in the heart rather than merely restoring suitable systemic parameters. Recent research has provided deeper insight into the metabolic etiology of diabetic cardiomyopathy and numerous heart-specific targets that may substitute or reinforce current strategies. From both experimental and translational perspectives, in this review we first discuss the progress made with conventional therapies, and then focus on the need for prospective metabolic targets that may avert myocardial vulnerability and functional decline in next-generation diabetic care.
糖尿病性心肌病被定义为在无冠状动脉疾病和高血压的情况下，由心脏能量底物改变引发的心室功能障碍。除了已证实的与糖尿病相关的心血管事件负担外，糖尿病性心肌病部分解释了为什么糖尿病患者更容易发生心力衰竭，以及心肌缺血后预后更差。糖尿病患者心血管疾病患病率的上升和成本的累积凸显了三级预防的不足，并呼吁改变治疗方法。越来越清楚的是，有效预防和治疗糖尿病性心肌病需要采取措施来调节心脏中发生的代谢紊乱，而不仅仅是恢复合适的全身参数。最近的研究对糖尿病性心肌病的代谢病因以及众多可能替代或强化当前策略的心脏特异性靶点有了更深入的了解。从实验和转化的角度来看，在这篇综述中，我们首先讨论传统疗法取得的进展，然后重点关注前瞻性代谢靶点在下一代糖尿病护理中避免心肌易损性和功能下降的必要性。
