INS and familial dilated cardiomyopathy: At present, the recognized pathogenic factors of DCM mainly include impaired myocardial insulin signaling and calcium metabolism, systemic glucose and lipid metabolic disorders, elevation in advanced glycation end products (AGEs), mitochondrial dysfunction, accumulation of reactive oxygen species (ROS), activation of inflammation, endoplasmic reticulum (ER) stress, extracellular matrix (ECM) deposition, abnormal coronary microcirculation, endothelial dysfunction, activation of the renin–angiotensin–aldosterone system (RAAS), and cardiac autonomic neuropathy [1,6,7,45].