Insulin resistance: focus on the pathogenesis of cardiomyopathy

Insulin resistance is the main link of pathogenesis of a lot of diseases, including cardiovascular diseases which are the leading cause of morbidity and mortality worldwide. The combination of insulin resistance – associated disorders, such as obesity, type 2 diabetes mellitus, arterial hypertension and hypertriglyceridemia, refers to metabolic syndrome. The increase in the number of patients with metabolic syndrome is due to a prevalence of unhealthy lifestyle and inappropriate di-etary pattern in the modern world, and is also partially associated with the trend of population aging in most developed countries. In this regard, it is necessary to emphasize the relevance of the link between insulin resistance and the development of a specific complication – metabolic cardiomyopathy. Given that the triggering event in pathogenesis of this cardiomyopathy is alterations in substrate balance with following accumulation of lipotoxic metabolites in cardiomyocytes, the term “lipotoxic cardiomyopathy” has been proposed. This cardiomyodystrophy is associated with myocardial hypertrophy and diastolic dysfunction, which thereafter result into chronic heart failure with a preserved ejection fraction. Although the link between the lipotoxic cardiomyodystrophy and insulin resistance–associated disorders is quite close, till now all therapeutic strategies involving only complex therapy with antidiabetic and lipid-lowering drugs have not led to a decrease in the risk for cardiomyopathy. There is a need in searching for effective therapeutic strategies to reduce the incidence of both lipotoxic cardiomyody-strophy and associated chronic heart failure.