Diabetic individuals have a significantly increased likelihood of developing
cardiovascular disease. Whilst part of this association is explained by the presence of concomitant risk factors, large epidemiological studies have consistently reported diabetes as a strong risk factor for the development of
heart failure after adjusting for such covariates. This has resulted in the notion that there is a distinct
cardiomyopathy specific to diabetes, termed '
diabetic cardiomyopathy'. The natural history is characterized by a latent subclinical period, during which there is evidence of diastolic dysfunction and
left ventricular hypertrophy, before overt
clinical deterioration and systolic failure ensue. These clinical findings have been supported by a growing body of experimental data which support the notion that diabetes inflicts a direct insult to the myocardium, with cellular, structural and functional changes manifest as the diabetic myocardial phenotype. Several of these mechanisms appear to work in unison, forming complicated reciprocal pathways of disease.
Reactive oxygen species and alterations in intracellular
calcium homeostasis appear to play significant roles in many of these mechanisms. Determining the hierarchy of this cascade of disease will allow identification of the pathological trigger most responsible for disease. Translational research in this field is currently hindered by a lack of clinical studies and intervention trials specifically in patients with
diabetic cardiomyopathy. Future clinical and experimental studies of accurate models of
diabetic cardiomyopathy should help to define the true aetiology and lead to the development of specific
pharmacotherapies for this condition, ultimately reducing the increased cardiovascular morbidity and mortality in diabetic patients.