Diabetes mellitus, the renin-angiotensin-aldosterone system, and the heart.
With diabetes mellitus reaching epidemic proportions, mainly secondary to obesity, the impact of cardiovascular disease due to this combination makes it a dominant public health problem during the first quarter of the 21st century. The complex interaction that results in diabetic heart disease is created by overlapping mechanisms. There is a propensity to develop premature, diffuse atherosclerotic coronary disease, which is associated with adverse short- and long-term morbidity and mortality. There are structural and functional abnormalities of the microvasculature, autonomic dysfunction, and intrinsic failure of myocardial contraction (so-called diabetic cardiomyopathy). These changes are amplified by arterial hypertension and kidney disease. In this review, we consider the role of the renin-angiotensin-aldosterone system and how it is a crucial driver of most of the pathophysiologic mechanisms behind diabetic heart disease and why in the past 5 years blocking this system in diabetic patients has emerged as a critical therapeutic intervention.
Lim
Hoong Sern
HS
University Department of Medicine, City Hospital, Birmingham, England.
MacFadyen
Robert J
RJ
Lip
Gregory Y H
GY
D002986:Clinical Trials as Topic; D003920:Diabetes Mellitus / Q000209:etiology / Q000503:physiopathology*; D006331:Heart Diseases / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D012084:Renin-Angiotensin System / Q000502:physiology*; D012307:Risk Factors