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Left Ventricular Hypertrophy in Diabetic Cardiomyopathy: A Target for Intervention

Mohapradeep Mohan1,2, Adel Dihoum2, Ify R Mordi2

  • 1Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom.

Frontiers in Cardiovascular Medicine
|October 18, 2021
PubMed

Insights

Diabetic heart disease can cause asymptomatic left ventricular hypertrophy (LVH). Certain medications like allopurinol, SGLT2 inhibitors, and metformin show promise in regressing LVH, potentially preventing heart failure in high-risk patients.

Area of Science:

  • Cardiology
  • Endocrinology
  • Metabolic Disease

Background:

  • Diabetic heart disease is a significant complication of type 2 diabetes mellitus (T2DM).
  • Asymptomatic left ventricular hypertrophy (LVH) affects up to 50% of T2DM patients before symptomatic heart failure develops.
  • LVH in T2DM is a strong predictor of cardiovascular events, including heart failure, and its pathophysiology is not fully understood.

Purpose of the Study:

  • To review clinical studies on the regression of LVH in patients with and without T2DM.
  • To explore the potential of allopurinol, SGLT2 inhibitors, and metformin in LVH regression.
  • To highlight LVH as a potential therapeutic target for cardio-protective interventions in at-risk populations.

Main Methods:

  • Review of key clinical studies evaluating specific therapeutic interventions.
  • Analysis of the effects of allopurinol, SGLT2 inhibitors, and metformin on LVH regression.
  • Examination of underlying mechanisms including inflammation, oxidative stress, AMPK, and insulin resistance.

Main Results:

  • Antihypertensive treatments, particularly renin-angiotensin system blockers, partially reduce LVH but are not fully effective.
  • LVH persists in a significant portion of hypertensive patients even at target blood pressure.
  • Emerging evidence suggests inflammation, oxidative stress, AMPK, and insulin resistance play roles in T2DM-associated LVH.

Conclusions:

  • Asymptomatic LVH in T2DM represents a critical, potentially targetable stage for intervention.
  • Allopurinol, SGLT2 inhibitors, and metformin are being investigated for their efficacy in regressing LVH.
  • Further research into the mechanisms and therapeutic strategies for LVH regression is crucial for preventing heart failure in T2DM patients.

Keywords:
SGLT2 inhibitorsallopurinoldiabetic cardiomyopathy (DCM)heart failureleft ventricular hypertrophy (LVH)metformintype 2 diabetes mellitus

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