Department of Cardiovascular Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan.
Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama 700-8511, Japan.
Int J Mol Sci. 2022 Mar 25;23(7):3587. doi: 10.3390/ijms23073587.
There is a close relationship between diabetes mellitus and heart failure, and diabetes is an independent risk factor for heart failure. Diabetes and heart failure are linked by not only the complication of ischemic heart disease, but also by metabolic disorders such as glucose toxicity and lipotoxicity based on insulin resistance. Cardiac dysfunction in the absence of coronary artery disease, hypertension, and valvular disease is called diabetic cardiomyopathy. Diabetes-induced hyperglycemia and hyperinsulinemia lead to capillary damage, myocardial fibrosis, and myocardial hypertrophy with mitochondrial dysfunction. Lipotoxicity with extensive fat deposits or lipid droplets is observed on cardiomyocytes. Furthermore, increased oxidative stress and inflammation cause cardiac fibrosis and hypertrophy. Treatment with a sodium glucose cotransporter 2 (SGLT2) inhibitor is currently one of the most effective treatments for heart failure associated with diabetes. However, an effective treatment for lipotoxicity of the myocardium has not yet been established, and the establishment of an effective treatment is needed in the future. This review provides an overview of heart failure in diabetic patients for the clinical practice of clinicians.
糖尿病与心力衰竭密切相关，糖尿病是心力衰竭的独立危险因素。糖尿病和心力衰竭不仅通过缺血性心脏病等并发症相关联，还与基于胰岛素抵抗的葡萄糖毒性和脂毒性等代谢紊乱相关联。在没有冠状动脉疾病、高血压和瓣膜病的情况下出现的心脏功能障碍称为糖尿病性心肌病。糖尿病引起的高血糖和高胰岛素血症导致毛细血管损伤、心肌纤维化和伴有线粒体功能障碍的心肌肥大。在心肌细胞上观察到脂毒性，伴有广泛的脂肪沉积或脂滴。此外，氧化应激和炎症增加导致心脏纤维化和肥大。目前，钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂的治疗是糖尿病相关心力衰竭的最有效治疗方法之一。然而，尚未确定针对心肌脂毒性的有效治疗方法，未来需要建立有效的治疗方法。本综述为临床医生的临床实践提供了糖尿病患者心力衰竭的概述。
