Pua et al. recently analyzed the impact of DM on myocardial fibrosis in asymptomatic individuals with HTN, and found that diabetics had lower strain and higher replacement fibrosis, as well as upregulation of GDF-15 (growth differentiation factor 15), which was independently associated with replacement myocardial fibrosis, suggesting that inflammatory and immune mechanics could mediate fibrosis in this population [23]. This evidence concerns the gene GDF15 and diabetes mellitus.