Diabetes mellitus and heart failure — a modern look at the mechanisms of development

Heart failure (HF) is a pressing public health problem. According to the literature, the presence of diabetes mellitus (DM) significantly increases the risk of repeated hospitalizations and the length of hospital stay in patients with heart failure. The proportion of HF remains high due to increased life expectancy, higher prevalence of risk factors and improved survival rates. Currently, advances in the treatment of coronary heart disease (CHD) and valvular disease have significantly improved survival rates, but the prognosis for heart failure remains extremely poor. Among the most important medical problems, heart failure occupies a special place in patients with type 2 diabetes. DM contributes to the onset of HF through a variety of mechanisms, including a complex of specific structural, functional, and metabolic changes in the myocardium called diabetic cardiomyopathy. Despite the active study of the causes of cardiomyopathy, the search and implementation of new approaches in assessing the risk of developing this pathological phenomenon in patients with heart failure remains relevant. This review examines current hypotheses for the development of diabetic cardiomyopathy, such as insulin resistance, endothelial dysfunction, fibrosis, lipotoxicity, and energy disorders.