Figure 1.

Mechanisms of diabetic cardiomyopathy. Hyperglycemia and hyperlipidemia induce metabolic changes in the heart that cause mitochondrial dysfunction, oxidative stress, inflammation, and endoplasmic reticulum (ER) stress in cardiomyocytes. Oxidative stress, ER stress, and inflammation can trigger the renin–angiotensin–aldosterone system (RAAS), enhance cardiac sympathetic nerve activity, and calcium-handling dysfunction. These changes mediate cardiac hypertrophy, apoptosis, fibrosis, and microvascular dysfunction, resulting in diastolic and systolic dysfunction.