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. Author manuscript; available in PMC: 2017 Jun 14.
Published in final edited form as: Circulation. 2016 Jun 14;133(24):2459–2502. doi: 10.1161/CIRCULATIONAHA.116.022194

Figure 6. Pathophysiologic mechanisms of heart failure in diabetes.

Figure 6

Hyperglycemia, insulin resistance, and hyperinsulinemia, the main physiologic disturbances in diabetes, contribute to atherosclerotic cardiovascular disease (ASCVD), hypertension, and multiple derangements of cellular metabolism, function, and structure, as well as activation of the renin-angiotensin-aldosterone system (RAAS). The different cardiomyopathies that result from these processes clinically present as heart failure in diabetes. AGE, advanced glycation end-product; FFA, free fatty acids.