A thin, gel-like lining inside the heart’s tiniest blood vessels may hold the key to treating heart failure in people with diabetes, according to new research led by the University of Bristol and published in Diabetologia.
The study, funded by the British Heart Foundation, identifies damage to this protective layer—called the glycocalyx—as a potential cause of heart failure in people with diabetes, and shows that repairing it may improve heart function.
The glycocalyx is a soft, protective coating that lines the inside of all blood vessels. It helps control how fluids and nutrients pass from the blood into nearby tissues, including the heart muscle.
When it’s healthy, the glycocalyx acts like a filter, protecting blood vessels and ensuring the right balance of nutrients and fluids. But when it’s damaged, especially in the small vessels of the heart, it can lead to serious problems.
In this study, researchers looked at mice with both type 1 and type 2 diabetes. They found that the glycocalyx in the heart’s small blood vessels was significantly damaged. As a result, too much fluid leaked into the walls of the heart, causing swelling and making the heart muscle stiffer.
This stiffness made it harder for the heart to relax between beats, which is essential for healthy blood flow. If the heart can’t relax properly, it eventually loses its ability to pump blood efficiently, leading to heart failure.
To test whether this damage could be reversed, the team treated diabetic mice with a substance called angiopoietin-1, which is known to help restore the glycocalyx. Just three hours after treatment, the researchers saw that the glycocalyx in the mice’s heart vessels had started to recover—both in thickness and coverage.
More importantly, ultrasound scans showed that the hearts of these mice could relax more normally, indicating improved function.
This discovery may help explain why many people with diabetes develop heart failure even when they don’t have the usual risk factors, like high blood pressure or blocked arteries. In such cases, damage to the tiny blood vessels in the heart—not the large arteries—may be the hidden cause.
Professor Simon Satchell and Dr. Yan Qiu, who led the study, believe this opens up new possibilities for treatment. Instead of only focusing on large arteries or blood sugar control, doctors may eventually be able to target the small vessel lining—the glycocalyx—to prevent or reduce heart damage in people with diabetes.
The researchers now plan to study how the glycocalyx changes in human patients with diabetes and heart failure. They also want to explore whether protecting the glycocalyx from early damage might prevent the heart problems from developing in the first place.
Because the glycocalyx lines all blood vessels, not just those in the heart, this research could have broader impact, potentially helping prevent damage in other organs affected by diabetes, such as the kidneys and eyes.
Professor James Leiper of the British Heart Foundation said the findings are “the first evidence that damage to the glycocalyx in the heart’s small vessels may play a direct role in diabetic heart failure.” He added that if these results can be confirmed in humans, it could lead to new treatments for a form of heart failure that currently has no cure.
In summary, this study brings new hope by showing that targeting a fragile, often overlooked layer in the heart’s smallest blood vessels may one day help millions of people with diabetes avoid one of the disease’s most serious complications—heart failure.
If you care about diabetes, please read studies that flaxseed oil is more beneficial than fish oil to people with diabetes, and green tea could help reduce death risk in diabetes.
For more information about nutrition, please see recent studies that blueberries strongly benefit people with metabolic syndrome, and results showing vitamin D could improve blood pressure in people with diabetes.
The research findings can be found in Diabetologia.
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