And if that's the case, then the heart muscle has to utilize alternative sources of fuel. So essentially, it is like an engine, not necessarily running out of fuel, but you put in the wrong fuels and it doesn't work well. Diabetes causes, for example, the inner side of your blood wall not to work perfectly. They become [? teased, ?] and that alters their responses. They can get tighter. Heart failure is the inability of the heart to provide enough blood to the organs. The human body has a phenomenal capability to adapt. But what you may experience after a certain threshold, your heart just can't deal with it anymore, and the squeeze gets lower. And if your squeeze gets to a certain point, then you will get symptoms of heart failure.
When there is additional risk factors, like high cholesterol, the cholesterol particles, they can attach to this inner wall and get taken up into the artery and cause a plaque. Diabetes is quite frequently also associated with changes in blood clotting factors. So then when this inner wall is already activated, there may be a plaque developing. And this body response is to put a blood clot there. And then the artery clogs, and the patients get a heart attack and comes to the hospital.
We know from the largest early diabetes trials that have now been done 20 years ago, that if patients were cared for appropriately very early, that even after 20 years, it mattered. This means if I take care of myself, I can be all right.