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

Arch Intern Med. 2004 Sep 13;164(16):1737-48. doi: 10.1001/archinte.164.16.1737.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Clinical Trials as Topic
  • Diabetes Mellitus / etiology
  • Diabetes Mellitus / physiopathology*
  • Heart Diseases / etiology
  • Heart Diseases / physiopathology*
  • Humans
  • Renin-Angiotensin System / physiology*
  • Risk Factors