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Metabolic, structural and biochemical changes in diabetes and the development of heart failure – published online 07/01/2022

Ho graphical abstract

Kim L. Ho, Qutuba G. Karwi, David Connolly, Simran Pherwani, Ezra B. Ketema, John R. Ussher, Gary D. Lopaschuk

Diabetes increases the risk of heart failure by over two-fold, and the need to improve our understanding of the way in which this occurs is becoming ever important. In this issue, Ho et al (https://doi.org/10.1007/s00125-021-05637-7) summarise the cardiac metabolic, structural, and biochemical changes that occur in diabetes. The authors discuss how hyperlipidaemia and hyperglycaemia contribute to changes in fatty acid and glucose metabolism, and that structural remodelling of the heart occurs in the form of hypertrophy and fibrosis.  They go on to explore how, biochemically, impairments in calcium handling, glucotoxicity, lipotoxicity, and transcriptional and translational modifications all contribute to cardiac dysfunction in diabetes. The authors conclude by highlighting that with the increasing amount of research going into the mechanisms by which certain diabetes drugs improve cardiovascular outcomes, new therapeutic strategies are emerging to treat diabetes and heart failure. The figures from this review are available as a downloadable slideset.

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