Mineralocorticoid receptor antagonists and the metabolic syndrome.
Key components of the metabolic syndrome (MetS), ie, obesity and insulin resistance, are associated with increased aldosterone production and mineralocorticoid receptor (MR) activation. Both MetS and hyperaldosteronism are proinflammatory and pro-oxidative states associated with cardiovascular disease. This review discusses emerging data that MR activation may contribute to abnormalities seen in MetS. In view of these data, MR antagonists may be beneficial in MetS, not only by controlling hypertension but also by reversing inflammation, oxidative stress, and defective insulin signaling at the cellular-molecular level. Clinical trials have demonstrated benefits of MR antagonists in heart failure, hypertension, and diabetic nephropathy, but additional trials are needed to demonstrate the clinical significance of MR blockade in MetS.
Tirosh
Amir
A
Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA. atirosh@partners.org
Garg
Rajesh
R
Adler
Gail K
GK
D000450:Aldosterone; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D000077545:Eplerenone; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D007249:Inflammation / Q000503:physiopathology; D007333:Insulin Resistance; D050356:Lipid Metabolism; D008055:Lipids; D024821:Metabolic Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D009765:Obesity / Q000503:physiopathology*; D015398:Signal Transduction / Q000187:drug effects; D013148:Spironolactone / Q000031:analogs & derivatives / Q000627:therapeutic use
D000959:Antihypertensive Agents; D008055:Lipids; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000450:Aldosterone; D000077545:Eplerenone