Mechanisms by which angiotensin-converting enzyme inhibitors prevent diabetes and cardiovascular disease.
Angiotensin-converting enzyme (ACE) inhibitors are the first-line therapeutic agents for treating hypertension in patients with the cardiometabolic syndrome and those with diabetes. ACE inhibitor therapy reduces both microvascular and macrovascular complications in diabetes and appears to improve insulin sensitivity and glucose metabolism. Several recent studies indicate that ACE inhibitor therapy reduces the development of type 2 diabetes in persons with essential hypertension, a population with a high prevalence of insulin resistance. ACE inhibitor therapy has been shown to improve surrogates of cardiovascular disease (eg, vascular compliance, endothelial-derived nitric oxide production, vascular relaxation and plasma markers of inflammation, oxidative stress, and thrombosis) and reduce cardiovascular disease, renal disease progression, and stroke. This article explores potential mechanism by which ACE inhibition reduces the development of diabetes, improves these surrogate markers, and reduces cardiovascular disease and renal disease.
McFarlane
Samy I
SI
Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, State University of New York, Health Science Center at Brooklyn, Brooklyn, New York 11203, USA.
Kumar
Ashok
A
Sowers
James R
JR
D000804:Angiotensin II / Q000494:pharmacology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D000818:Animals; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control*; D002320:Cardiovascular Physiological Phenomena / Q000187:drug effects; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000209:etiology; D051381:Rats
D000806:Angiotensin-Converting Enzyme Inhibitors; D000804:Angiotensin II