Diabetes mellitus, the renin-angiotensin-aldosterone system, and the heart

Hoong Lim, Robert Macfadyen, Gregory Lip

Research output: Contribution to journalReview article

93 Citations (Scopus)


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 21 st 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 reninangiotensin-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.
Original languageEnglish
Pages (from-to)1737-1748
Number of pages12
JournalArchives of Internal Medicine
Issue number16
Publication statusPublished - 1 Sept 2004


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