Abstract
Diabetes mellitus (DM) and heart failure (HF) are frequent comorbidities among elderly patients. HF, a leading cause of mortality and morbidity worldwide, is characterized by sympathetic nervous system hyperactivity. The prevalence of diabetes mellitus (DM) is rapidly growing and the risk of developing HF is higher among DM patients. DM is responsible for several macro- and micro-angiopathies that contribute to the development of coronary artery disease (CAD), peripheral artery disease, retinopathy, neuropathy and diabetic nephropathy (DN) as well. Independently of CAD, chronic kidney disease (CKD) and DM increase the risk of HF. Individuals with diabetic nephropathy are likely to present a distinct pathological condition, defined as diabetic cardiomyopathy, even in the absence of hypertension or CAD, whose pathogenesis is only partially known. However, several hypotheses have been proposed to explain the mechanism of diabetic cardiomyopathy: increased oxidative stress, altered substrate metabolism, mitochondrial dysfunction, activation of renin–angiotensin–aldosterone system (RAAS), insulin resistance, and autonomic dysfunction. In this review, we will focus on the involvement of sympathetic system hyperactivity in the diabetic nephropathy.
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Abbreviations
- HF:
-
Heart failure
- DM:
-
Diabetes mellitus
- CAD:
-
Coronary artery disease
- AF:
-
Atrial fibrillation
- SNS:
-
Sympathetic nervous system
- CA:
-
Cathecolamines
- βARs:
-
β-adrenergic receptors
- DN:
-
Diabetic nephropathy
- CKD:
-
Chronic kidney disease
- RAAS:
-
Renin–angiotensin–aldosterone system
- NE:
-
Norepinephrine
- EN:
-
Epinephrine
- GRK2:
-
G-protein coupled receptor kinase 2.
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G. Rengo was supported by the Ministry of Health (Italy) Grant Number GR-2011-02346878 and by San Paolo Bank of Naples and University of Naples Federico II—STAR Program 2016.
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GR and KK contributed to the review conception and design. KK, GM F, CdL, AC and LB conducted the literature searches and reviewed the identified articles. AC and GC provided critical analysis. DL and NF revised the manuscript for intellectual content. All authors read and approved the final manuscript.
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Komici, K., Femminella, G.D., de Lucia, C. et al. Predisposing factors to heart failure in diabetic nephropathy: a look at the sympathetic nervous system hyperactivity. Aging Clin Exp Res 31, 321–330 (2019). https://doi.org/10.1007/s40520-018-0973-2
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DOI: https://doi.org/10.1007/s40520-018-0973-2