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Diabetes, the Renin-Angiotensin System and Heart Disease

[ Vol. 1 , Issue. 2 ]


Hoong Sern Lim and Gregory Y.H. Lip   Pages 225 - 238 ( 14 )


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-angiotensinaldosterone 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-angiotensinaldosterone system, the complex entity of diabetes-related heart disease and the (emerging) evidence for specific inhibition of the renin-angiotensin-aldosterone system in diabetes.


renin-angiotensin system, diabetes, cardiovascular disease


University Department of Medicine, City Hospital Birmingham, B18 7QH, England, UK

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