Fig. 2
From: Association between insulin resistance and the development of cardiovascular disease
Mechanisms implicated in the development of diabetic cardiomyopathy. Normally, the insulin signaling regulates the glucose and lipids metabolism in heart. Insulin resistance produces a metabolic derangement that results in high lipid oxidation and low of glucose oxidation. The activation of the renin–angiotensin–aldosterone system (RAAS) can cause mitochondrial dysfunction, endoplasmic reticulum stress and oxidative stress. This can results in abnormal Ca2+ handling and low ATP production leading to cardiomyocyte death. ER endoplasmic reticulum, FFA free fatty acids