What is the clinical evidence from this study?

Study design: Review. Population: Diabetic cardiomyopathy and COVID-19.

October 13, 2025Frontiers in Pharmacology7 citationsOpen Access

Diabetic cardiomyopathy and COVID-19: intersecting pathways and amplified cardiovascular risk

SPSwati PrakashUniversity of Lucknow PCPriyanka ChoudhuryIndian Institute of Technology Kharagpur SBShradha BishtUttaranchal University

Key Result

Diabetic cardiomyopathy and COVID-19 share intersecting pathogenic pathways, such as RAAS dysregulation and endothelial damage, which synergistically amplify cardiovascular risk and myocardial injury.

Structured PICO

Population

Patients with diabetic cardiomyopathy and COVID-19

This review elucidates the shared pathophysiological mechanisms between diabetic cardiomyopathy and COVID-19, highlighting how their intersection amplifies cardiovascular risk and severity of disease.

Limitations

Much of the current evidence derives from animal models or post-mortem studies.
The precise pathways linking coronary microvascular impairment to clinical outcomes remain incompletely understood.
Additional longitudinal studies are required to clarify whether COVID-19 accelerates the trajectory of diabetic vascular complications or unmasks pre-existing subclinical disease.

Abstract

Diabetic cardiomyopathy (DCM) is a diabetes-induced heart condition characterized by ventricular dysfunction without other cardiac diseases. Chronic hyperglycemia, insulin resistance, and metabolic disturbances drive myocardial damage through renin-angiotensin-aldosterone system (RAAS) activation, oxidative stress, mitochondrial dysfunction, advanced glycation end product (AGE) accumulation, and persistent inflammation. The COVID-19 pandemic, caused by SARS-CoV-2, has intensified cardiovascular risk in diabetic patients. The virus uses ACE2 receptors, abundant in the heart and other organs, enabling multi-organ injury. COVID-19 may worsen glucose control or induce new-onset diabetes via pancreatic injury, insulin resistance, and stress hyperglycemia. Pre-existing diabetes increases the risk of severe COVID-19, cytokine storms, endothelial dysfunction, and thrombosis. In combination, both conditions promote RAAS imbalance, exaggerated inflammation, and hypercoagulability, amplifying myocardial injury, fibrosis, and heart failure risk. This review highlights the intricate bidirectional relationship between DCM and COVID-19, emphasizing shared pathogenic mechanisms such as RAAS dysregulation, endothelial damage, cytokine overproduction, and coagulopathy. Understanding these overlapping pathways is crucial for developing effective preventive and therapeutic strategies to mitigate adverse outcomes in this vulnerable population.

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