Fan Yajie, Yan Zhipeng, Li Tingting, Li Aolin, Fan Xinbiao, Qi Zhongwen, Zhang Junping
Department of Cardiovascular, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
Department of Cardiovascular, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
Diabetes Metab J. 2024 Jan;48(1):19-36. doi: 10.4093/dmj.2023.0110. Epub 2024 Jan 3.
Insulin resistance has been regarded as a hallmark of diabetes heart disease (DHD). Numerous studies have shown that insulin resistance can affect blood circulation and myocardium, which indirectly cause cardiac hypertrophy and ventricular remodeling, participating in the pathogenesis of DHD. Meanwhile, hyperinsulinemia, hyperglycemia, and hyperlipidemia associated with insulin resistance can directly impair the metabolism and function of the heart. Targeting insulin resistance is a potential therapeutic strategy for the prevention of DHD. Currently, the role of insulin resistance in the pathogenic development of DHD is still under active research, as the pathological roles involved are complex and not yet fully understood, and the related therapeutic approaches are not well developed. In this review, we describe insulin resistance and add recent advances in the major pathological and physiological changes and underlying mechanisms by which insulin resistance leads to myocardial remodeling and dysfunction in the diabetic heart, including exosomal dysfunction, ferroptosis, and epigenetic factors. In addition, we discuss potential therapeutic approaches to improve insulin resistance and accelerate the development of cardiovascular protection drugs.
胰岛素抵抗被视为糖尿病性心脏病（DHD）的一个标志。大量研究表明，胰岛素抵抗会影响血液循环和心肌，间接导致心脏肥大和心室重塑，参与DHD的发病机制。同时，与胰岛素抵抗相关的高胰岛素血症、高血糖和高血脂会直接损害心脏的代谢和功能。针对胰岛素抵抗是预防DHD的一种潜在治疗策略。目前，胰岛素抵抗在DHD致病发展中的作用仍在积极研究中，因为涉及的病理作用复杂且尚未完全了解，相关治疗方法也未得到充分发展。在这篇综述中，我们描述了胰岛素抵抗，并介绍了胰岛素抵抗导致糖尿病心脏心肌重塑和功能障碍的主要病理生理变化及潜在机制的最新进展，包括外泌体功能障碍、铁死亡和表观遗传因素。此外，我们还讨论了改善胰岛素抵抗和加速心血管保护药物开发的潜在治疗方法。
