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Review: Aldosterone antagonism in type 2 diabetes mellitus — a new therapeutic approach to diabetic macrovascular disease?

Department of Medicine & Therapeutics, Level 7, Ninewells Hospital, Dundee, UK, krishnan.swaminathan{at}nhs.net

Justine Davies

Department of Medicine & Therapeutics, Level 7, Ninewells Hospital, Dundee, UK

Allan Struthers

Department of Medicine & Therapeutics, Level 7, Ninewells Hospital, Dundee, UK

The renin-angiotensin-aldosterone system has long been a target of pharmacological approaches for the control of blood pressure and increasingly for heart failure, myocardial infarction, nephropathy and diabetes. Clinical trials involving the renin-angiotensin-aldosterone axis have traditionally focused on angiotensin-converting enzyme (ACE) inhibitors or angiotensin (Ang) II receptor blockers, thereby laying the emphasis on inhibiting Ang II. It is now acknowledged that aldosterone is also an important culprit in addition to Ang II. Recently, major intervention trials in heart failure have demonstrated the marked cardiovascular beneficial effect of aldosterone antagonism over and above ACE-inhibitor therapy, underscoring the harmful effects of aldosterone in cardiovascular disease. Diabetes is now increasingly recognised as not only a metabolic disorder but a vascular disease as well. Therefore, the prospect arises that aldosterone antagonism may translate in reduced cardiovascular risk in a high-risk disorder like diabetes mellitus. If so, aldosterone antagonists may offer a new therapy in diabetes mellitus for the primary prevention of cardiovascular disease.

Br J Diabetes Vasc Dis 2008;8:16-19

Key Words: aldosterone • macrovascular disease • therapeutics • type 2 diabetes.

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The British Journal of Diabetes & Vascular Disease, Vol. 8, No. 1, 16-19 (2008)
DOI: 10.1177/14746514080080010501


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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Swaminathan, K. Articles by Struthers, A. Search for Related Content Social Bookmarking                         What's this?