Tratamento do remodelamento cardíaco associado ao diabetes mellitus tipo II com fármacos que atuam sobre o Sistema Renina Angiotensina-Aldosterona

Abstract

The World Health Organization predicts that about 31% of the world population will die of some cardiovascular disease (CVD). One of the factors contributing to this projection is the great number of obese, which has been progressively increased. Besides constituting a cardiovascular risk factor independent, obesity is a major risk factor for the development of type II diabetes mellitus (DM). It is well accepted that chronic type II DM-associated complications are essentially CVD. However, diabetic cardiomyopathy, a term that designates a set of structural pathological and functional changes even in the absence of hemodynamic changes, keeps underestimated and untreated. The treatment of diabetic cardiomyopathy can represents improvement in clinical outcomes, since many studies have shown a positive association between increased cardiac mass, which defines left ventricular hypertrophy (LVH), with enhanced morbidity and mortality. In this scenario, we focus our review in experimental studies demonstrating the effectiveness of drugs, whose beneficial effects on CVD-associated LVH (as hypertension or coronary artery disease) are already demonstrated, on cardiac remodeling associated with obesity/ type II DM. The majority of the studies show a clear involvement of the renin-angiotensinaldosterone system (RAAS) on diabetic cardiomyopathy and, therefore, drugs that inhibit RAAS are promising for the treatment of the pathological remodeling on obesity. It was found that the LVH is a frequent feature in experimental models of obesity/ type II DM. When these animals were treated with AT1 receptor antagonists, angiotensin-II converting enzyme inhibitors, renin inhibitor and aldosterone antagonists, the cardiac benefits were notable and pressure-independents. It was also observed that activation of angiotensin(1-7) signaling is a pharmacological target, but not experimentally tested yet. We conclude that it is desirable treating diabetic cardiomyopathy, and that the most promising pharmacological intervention is drugs commonly used as antihypertensive.