Potential mechanisms linking diabetes mellitus to heart failure. Diabetes mellitus is associated with multiple physiopathological changes in the cardiovascular system. Among these, endothelial dysfunction and hemostatic disorders may at least in part account for the higher risk of coronary artery disease (CAD) while microangiopathy, myocardial fibrosis, and abnormal myocardial metabolism have been implicated in the pathogenesis of a specific diabetic cardiomyopathy. When it occurs in diabetic patients, heart failure (HF) is, in most cases, a consequence of CAD; other possible causes include the comorbidities frequently encountered in diabetic patients such as hypertension, or other causes of nonischemic cardiomyopathy. The existence of a diabetic cardiomyopathy may increase the risk of HF in response to these insults; however, whether diabetic cardiomyopathy alone may be responsible for HF remains unknown.