CMS and Type 2 Diabetes Mellitus: Bound Together by the Renin Angiotensin Aldosterone System

Abstract

The recent epidemic of obesity has led to an increasing incidence of the cardiometabolic syndrome defined by the NCEP ATP III guidelines as a cluster of abdominal obesity, low HDL, high triglycerides, HTN, and impaired fasting glucose. Obesity predisposes the body to a state of inflammation, insulin resistance, and hyperinsulinemia, and individuals with the metabolic syndrome are at increased risk for developing CAD, stroke, PVD, CKD, and T2DM. There are various mechanisms by which these complications of the metabolic syndrome occur, and activation of systemic and local renin angiotensin aldosterone system (RAAS) and resultant oxidative stress in different organ systems is probably the most important one. Finally, based on recent trials, the approach toward management of the metabolic syndrome is usually multifactorial and multiagent and studies are still being performed to assess the efficacy of newer drugs.