Cardiomyopathy in diabetics: A review of current opinion on the underlying pathological mechanisms

Diabetes is one of the few growing causes of a cardiomyopathy around the world and cardiomyopathy is a common complication of diabetes causing significant mortality and morbidity. This cardiomyopathy is seen commonly in young people with diabetes and those without pre-existing coronary artery disease, suggestive of a specific entity linked directly to diabetes. In recent years there has been a real upsurge in the research devoted to this growing problem as other causes of heart disease such as tobacco smoking wane. More and more animal model studies and human tissue studies have enabled researchers to begin to develop ideas of the processes causing this cardiomyopathy. As the pathological processes causing this cardiomyopathy are beginning to be better understood, we present an overview of the various potential pathological mechanisms under investigation that may constitute a cardiomyopathy related to diabetes. In our review we describe 6 possible processes, which may begin to explain the cardiomyopathy related to diabetes beyond the standard ischaemia-infarct model. These mechanisms which are still under investigation include, reduced metabolic function, reactive oxygen species damage, damage to the ryanodine receptor, up-regulation of ADH, a cardiac autonomic neuropathy, and changes in cardiac structure.