Lim Hoong Sern, MacFadyen Robert J, Lip Gregory Y H
University Department of Medicine, City Hospital, Birmingham, England.
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.
随着糖尿病（主要继发于肥胖）呈流行趋势，这种组合导致的心血管疾病影响使其成为21世纪第一个季度的主要公共卫生问题。导致糖尿病性心脏病的复杂相互作用是由重叠机制产生的。存在发生过早、弥漫性动脉粥样硬化性冠状动脉疾病的倾向，这与不良的短期和长期发病率及死亡率相关。存在微血管结构和功能异常、自主神经功能障碍以及心肌收缩内在功能衰竭（即所谓的糖尿病性心肌病）。这些变化因动脉高血压和肾脏疾病而加剧。在本综述中，我们探讨肾素 - 血管紧张素 - 醛固酮系统的作用，以及它如何成为糖尿病性心脏病背后大多数病理生理机制的关键驱动因素，以及为何在过去5年中，在糖尿病患者中阻断该系统已成为一种关键的治疗干预措施。
