Uzasadnione wydaje się także podawanie antagonistów aldosteronu, takich jak spironolakton i eplerenon. Mają one ewidentne działanie antyfibrotyczne, jednak ich skuteczność w leczeniu kardiomiopatii cukrzycowej nie została dotychczas jednoznacznie potwierdzona w badaniach naukowych. Stosowanie tych leków przy braku przekonywujących wskazań (takich jak zaawansowana dysfunkcja skurczowa z EF ≤35%) może wiązać się z ryzykiem rozwoju niewydolności nerek i hiperkaliemii.

Inne metody leczenia, takie jak stosowanie: antyoksydantów, L-karnityny, mioinozytolu, ranolazyny, perheksyliny czy metioniny nie wyszły dotychczas poza badania eksperymentalne i nie ma dowodów na ich skuteczność w leczeniu kardiomiopatii cukrzycowej [59].

Podsumowanie

Niewyjaśnione pozostaje, czy kardiomiopatia cukrzycowa zasługuje na miano odrębnej jednostki chorobowej. Nie ma jednak wątpliwości, że w cukrzycy zarówno typu 1, jak i 2 mamy do czynienia z rozwojem wielopoziomowych patologii, które mogą mieć potencjalnie szkodliwy wpływ na funkcję serca. Najczęściej wyraża się to ocenianymi w badaniu echokardiograficznym zaburzeniami funkcji rozkurczowej. Aby nie dopuścić do rozwoju dysfunkcji skurczowej, należy najpierw dążyć do optymalnego wyrównania metabolicznego, a następnie stosować leki o udowodnionej skuteczności w leczeniu niewydolności serca. W praktyce klinicznej cukrzycy towarzyszy jednak zazwyczaj nadciśnienie tętnicze, dyslipidemia lub choroba niedokrwienna serca. Ze względu na wspólne elementy patofizjologii prawidłowo prowadzone (w oparciu o wytyczne towarzystw naukowych) leczenie tych stanów chorobowych zmniejsza jednocześnie ryzyko powstania i progresji kardiomiopatii cukrzycowej. Jej obecność można podejrzewać w razie mikroalbuminurii, dużych stężeń HbA1C czy zaburzeń autonomicznych, takich jak hipotonia ortostatyczna.

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