Below is an instruction from Human. Write a response.
    ### Instruction:
    What causes Diabetic Heart Disease ?
    ### Response:
    At least four complex processes, alone or combined, can lead to diabetic heart disease (DHD). They include coronary atherosclerosis; metabolic syndrome; insulin resistance in people who have type 2 diabetes; and the interaction of coronary heart disease (CHD), high blood pressure, and diabetes.
    