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Samy I. McFarlane, James R. Sowers, Aldosterone Function in Diabetes Mellitus: Effects on Cardiovascular and Renal Disease, The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 2, 1 February 2003, Pages 516–523, https://doi.org/10.1210/jc.2002-021443
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Type 2 diabetes and its complications are increasing rapidly in Westernized, industrialized societies, in part, because the population is aging and becoming more obese and sedentary (1–6). Type 2 diabetes is also more common in minority populations, including Hispanics and African Americans, whose relative numbers are increasing in this country (1). Up to 20 million people in the United States have diabetes, of whom approximately 4–5 million are unaware that they have this disorder (5, 6). Diabetes is the most frequent underlying cause of new blindness, end stage renal disease, and lower extremity amputations in the United States (1–3). Diabetes also leads to premature cardiovascular disease (CVD; Refs. 2–4), stroke (7–13), and markedly increased premature mortality (2, 3). The role of the renin-angiotensin aldosterone system (RAAS) in increasing the risk for hypertension and CVD in patients with type 2 diabetes has recently engendered considerable interest (13–22). In this review, we will present the evidence supporting the role of aldosterone as a risk factor above and beyond that of angiotensin II (Ang II) in the pathophysiology of CVD in people with diabetes. We will also discuss the potential benefits of blocking the cardiovascular and renal actions of aldosterone in lessening the burden of CVD and renal disease in these patients (13–25).
