title: Update on RAAS Modulation for the Treatment of Diabetic Cardiovascular Disease.
abstract: Since the advent of insulin, the improvements in diabetes detection and the therapies to treat hyperglycemia have reduced the mortality of acute metabolic emergencies, such that today chronic complications are the major cause of morbidity and mortality among diabetic patients. More than half of the mortality that is seen in the diabetic population can be ascribed to cardiovascular disease (CVD), which includes not only myocardial infarction due to premature atherosclerosis but also diabetic cardiomyopathy. The importance of renin-angiotensin-aldosterone system (RAAS) antagonism in the prevention of diabetic CVD has demonstrated the key role that the RAAS plays in diabetic CVD onset and development. Today, ACE inhibitors and angiotensin II receptor blockers represent the first line therapy for primary and secondary CVD prevention in patients with diabetes. Recent research has uncovered new dimensions of the RAAS and, therefore, new potential therapeutic targets against diabetic CVD. Here we describe the timeline of paradigm shifts in RAAS understanding, how diabetes modifies the RAAS, and what new parts of the RAAS pathway could be targeted in order to achieve RAAS modulation against diabetic CVD.
authors.affiliation: Department of Medical Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy; Division of Medicina Clinica, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy.
authors.forename: Stella
authors.identifier: 0000-0002-7429-3075
authors.initials: S
authors.lastname: Bernardi
authors.affiliation: Department of Medical Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Michelli
authors.affiliation: Department of Medical Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Zuolo
authors.affiliation: Diabetes Centre, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Via Puccini, 34100 Trieste, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Candido
authors.affiliation: Department of Medical Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy; Division of Medicina Clinica, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Cattinara Teaching Hospital, Strada di Fiume, 34100 Trieste, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fabris
mesh_terms: D057912:Angiotensin II Type 2 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D058065:Diabetic Cardiomyopathies / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans
chemical_list: D057912:Angiotensin II Type 2 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors