Diabetes, the renin-angiotensin system and heart disease.
Despite recent advances, cardiovascular disease continues to be the leading cause of death among patients with diabetes. Diabetes-related heart disease makes up the majority of the cardiovascular morbidity and mortality and this clinical entity results from synergistic interaction amongst various overlapping mechanisms. Diabetes-related heart disease is characterised by a propensity to develop premature, diffuse atherosclerotic disease, structural and functional abnormalities of the microvasculature, autonomic dysfunction and intrinsic myocardial dysfunction (the so-called diabetic 'cardiomyopathy'), all of which are exacerbated by hypertension and diabetic nephropathy. The renin-angiotensin-aldosterone system possesses various autocrine and paracrine effects which drive most of the pathophysiological mechanisms in diabetes-related heart disease. This review aims to describe the expanding role of the renin-angiotensin-aldosterone system, the complex entity of diabetes-related heart disease and the (emerging) evidence for specific inhibition of the renin-angiotensin-aldosterone system in diabetes.
University Department of Medicine, City Hospital Birmingham, England, UK.
Hoong Sern
HS
Lim
Gregory Y H
GY
Lip
D002986:Clinical Trials as Topic; D048909:Diabetes Complications / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000503:physiopathology; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D012084:Renin-Angiotensin System / Q000502:physiology*; D012307:Risk Factors