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Cardiac effects of HDL and its components on diabetic cardiomyopathy
Frank Spillmann1, Sophie Van Linthout, Carsten Tschöpe
1Department of Cardiology and Pneumology, Charité, University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
Insights
High-density lipoprotein (HDL) plays a crucial role in diabetic cardiomyopathy. Altered HDL influences metabolic triggers and directly impacts cardiac cells, contributing to heart dysfunction in diabetes.
Area of Science:
- Cardiology
- Metabolic Diseases
- Endocrinology
Background:
- Diabetic cardiomyopathy is a distinct heart condition in diabetes mellitus, separate from coronary heart disease and hypertension.
- Key metabolic disturbances in diabetes, including hyperglycemia, hyperinsulinemia, and hyperlipidemia, alter cardiac structure and function.
- High-density lipoprotein (HDL) alterations are both a consequence and a potential contributor to diabetes and its associated cardiomyopathy.
Purpose of the Study:
- To review the multifaceted role of HDL in the development and progression of diabetic cardiomyopathy.
- To elucidate the indirect mechanisms by which HDL influences metabolic triggers of diabetic cardiomyopathy.
- To examine the direct effects of HDL on cellular consequences within the heart characteristic of diabetic cardiomyopathy.
Main Methods:
- Literature review synthesizing current research on HDL, diabetes mellitus, and cardiomyopathy.
- Analysis of indirect pathways linking HDL to hyperglycemia, hyperinsulinemia, and hyperlipidemia.
- Examination of direct cellular impacts of HDL on cardiac inflammation, oxidative stress, apoptosis, fibrosis, calcium handling, glucose homeostasis, and endothelial function.
Main Results:
- Altered HDL (low or dysfunctional) is implicated in the pathogenesis of diabetic cardiomyopathy.
- HDL influences key metabolic disturbances (hyperglycemia, hyperinsulinemia, hyperlipidemia) that drive cardiac changes.
- HDL directly affects cellular processes in the heart, including inflammation, oxidative stress, apoptosis, fibrosis, and endothelial dysfunction.
Conclusions:
- HDL is a significant factor in diabetic cardiomyopathy, acting through both metabolic and direct cellular pathways.
- Understanding HDL's role offers potential therapeutic targets for managing diabetic heart disease.
- Further research into HDL's complex interactions is crucial for preventing and treating diabetic cardiomyopathy.
Abstract:
Diabetic cardiopathy includes a specific cardiomyopathy, which occurs in the absence of coronary heart disease and hypertension under diabetes mellitus. Hyperglycemia, hyperinsulinemia, and hyperlipidemia, characteristic metabolic disturbances evident in diabetes mellitus, all three lead to a specific altered cardiac structure and function. Recently, it has been demonstrated that altered HDL, be it low HDL or dysfunctional HDL is not only a consequence of diabetes mellitus, but can also contribute to the development of diabetes mellitus, and therefore also of diabetic cardiomyopathy. This review summarizes how HDL can indirectly affect diabetic cardiomyopathy via their influence on the metabolic triggers hyperglycemia, hyperinsulinemia, and hyperlipidemia, and how they can directly influence the cardiac cellular consequences, typical for diabetic cardiomyopathy, including inflammation, oxidative stress, apoptosis, fibrosis, Ca2+ handling, glucose homeostasis, and endothelial dysfunction.
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