Braga Manoela F B, Leiter Lawrence A
Cardiometabolic Risk Initiative, St. Michael's Hospital, University of Toronto, Toronto, Ontario Canada.
Am J Cardiol. 2009 Sep 15;104(6):835-9. doi: 10.1016/j.amjcard.2009.05.015.
The investigators review the evidence of the potential role of renin-angiotensin system (RAS) blockers in delaying or preventing the onset and progression of diabetes mellitus (DM) and cardiovascular disease and the suggested mechanisms by which these agents exert their favorable metabolic and cardiovascular effects. Data from clinical trials suggest that RAS blockade not only reduces cardiovascular risk in patients with DM but also may prevent or delay DM onset in at-risk subjects. These observations set the stage for further studies evaluating the risk for developing DM as a primary end point: the Diabetes Reduction Approaches With Ramipril And Rosiglitazone Medications (DREAM) trial, in which ramipril significantly increased regression to normoglycemia (although it did not reduce the primary end point of new-onset DM or death), and the ongoing Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial, the only DM prevention trial also powered to evaluate whether a reduced risk for DM is associated with a reduction in cardiovascular disease events. In conclusion, overwhelming evidence suggests that the RAS plays an important role in the pathogenesis of DM and its associated cardiovascular risks.
研究人员回顾了肾素-血管紧张素系统（RAS）阻滞剂在延缓或预防糖尿病（DM）及心血管疾病的发生和进展方面潜在作用的证据，以及这些药物发挥有利代谢和心血管效应的推测机制。临床试验数据表明，RAS阻断不仅可降低糖尿病患者的心血管风险，还可能预防或延缓高危人群发生糖尿病。这些观察结果为进一步研究将糖尿病发生风险作为主要终点奠定了基础：雷米普利与罗格列酮药物降低糖尿病风险（DREAM）试验，其中雷米普利显著增加了血糖恢复正常的比例（尽管它并未降低新发糖尿病或死亡的主要终点），以及正在进行的糖耐量受损患者那格列奈与缬沙坦转归研究（NAVIGATOR）试验，这是唯一一项有足够效力评估糖尿病风险降低是否与心血管疾病事件减少相关的糖尿病预防试验。总之，大量证据表明RAS在糖尿病发病机制及其相关心血管风险中起重要作用。
