Figure 1.

Pathophysiological Mechanisms by Which Enhanced Insulin Signaling May Lead to Heart Failure

Enhanced insulin signaling can lead to heart failure by exerting adverse effects on cardiac remodeling, promoting renal tubular sodium reabsorption, and stimulating accumulation and inflammation of epicardial adipose tissue, thereby aggravating its deleterious effects on the underlying myocardium. (Top) Drugs that potentiate insulin signaling (insulin, sulfonylureas, and thiazolidinediones). (Bottom) Drugs that attenuate insulin signaling (metformin and sodium-glucose cotransporter-2 [SGLT2] inhibitors).