Elucidating the therapeutic potential of natural products in alleviating diabetic cardiomyopathy: contemporary progress and forthcoming opportunities

BACKGROUND: Diabetes is a leading health challenge in the 21st century. According to the International Diabetes Federation, 783 million people will have diabetes by 2045. Diabetic cardiomyopathy is a prevalent complication of diabetes, characterized by the impaired left ventricular function that occurs independently of other cardiovascular diseases including atherosclerosis, coronary artery disease, hypertension. Currently, there is a pronounced lack of effective therapeutic strategies specifically targeting diabetic cardiomyopathy. PURPOSE: This review aims to demonstrate natural products' efficacy across different pathological dimensions of diabetic cardiomyopathy, thereby providing new insights for the therapy's development of diabetic cardiomyopathy. METHODS: Based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a systematic literature search was conducted to identify all relevant studies published between January 1, 2015, and March 31, 2025. The following databases were queried: PubMed, Web of Science, and Scopus. To ensure comprehensiveness, particularly for research published in Chinese, the China National Knowledge Infrastructure database was also searched. RESULTS: A total of 83 studies were retrieved that demonstrate the efficacy of natural products against diabetic cardiomyopathy, primarily targeting six predominant pathologies: fibrosis, oxidative stress, inflammation, mitochondrial dysfunction, programmed cell death, and gut microbiota dysbiosis. CONCLUSION: Natural products exhibit promising therapeutic effects against diabetic cardiomyopathy, making them a key resource for novel therapy development targeting diabetic cardiomyopathy.