Karwi Qutuba G, Ho Kim L, Pherwani Simran, Ketema Ezra B, Sun Qiuyu, Lopaschuk Gary D
Department of Pediatrics, Cardiovascular Research Centre, University of Alberta, 423 Heritage Medical Research Centre, Edmonton, Alberta T6G 2S2, Canada.
Cardiovasc Res. 2022 Feb 21;118(3):686-715. doi: 10.1093/cvr/cvab120.
Diabetes mellitus increases the risk of developing heart failure, and the co-existence of both diseases worsens cardiovascular outcomes, hospitalization, and the progression of heart failure. Despite current advancements on therapeutic strategies to manage hyperglycaemia, the likelihood of developing diabetes-induced heart failure is still significant, especially with the accelerating global prevalence of diabetes and an ageing population. This raises the likelihood of other contributing mechanisms beyond hyperglycaemia in predisposing diabetic patients to cardiovascular disease risk. There has been considerable interest in understanding the alterations in cardiac structure and function in diabetic patients, collectively termed as 'diabetic cardiomyopathy'. However, the factors that contribute to the development of diabetic cardiomyopathies are not fully understood. This review summarizes the main characteristics of diabetic cardiomyopathies, and the basic mechanisms that contribute to its occurrence. This includes perturbations in insulin resistance, fuel preference, reactive oxygen species generation, inflammation, cell death pathways, neurohormonal mechanisms, advanced glycated end-products accumulation, lipotoxicity, glucotoxicity, and post-translational modifications in the heart of the diabetic. This review also discusses the impact of antihyperglycaemic therapies on the development of heart failure, as well as how current heart failure therapies influence glycaemic control in diabetic patients. We also highlight the current knowledge gaps in understanding how diabetes induces heart failure.
糖尿病会增加发生心力衰竭的风险，而这两种疾病并存会使心血管结局、住院情况及心力衰竭的进展恶化。尽管目前在管理高血糖的治疗策略方面取得了进展，但发生糖尿病性心力衰竭的可能性仍然很大，尤其是在全球糖尿病患病率不断上升和人口老龄化加速的情况下。这增加了除高血糖之外的其他促成机制使糖尿病患者易患心血管疾病风险的可能性。人们对了解糖尿病患者心脏结构和功能的改变（统称为“糖尿病性心肌病”）有着浓厚的兴趣。然而，导致糖尿病性心肌病发生的因素尚未完全明确。本综述总结了糖尿病性心肌病的主要特征以及导致其发生的基本机制。这包括胰岛素抵抗、燃料偏好、活性氧生成、炎症、细胞死亡途径、神经激素机制、晚期糖基化终产物积累、脂毒性、糖毒性以及糖尿病患者心脏中的翻译后修饰等方面的紊乱。本综述还讨论了降糖治疗对心力衰竭发生的影响，以及当前的心力衰竭治疗如何影响糖尿病患者的血糖控制。我们还强调了在理解糖尿病如何诱发心力衰竭方面目前存在的知识空白。
