Role of mineralocorticoid receptor in diabetic vascular disease

Purpose of review Recent studies have suggested that mineralocorticoid receptor activation leads to cardiovascular and renovascular injury through mechanisms that are largely independent of aldosterone's classic effects on fluid and electrolyte balance. This review provides an overview of this literature and discusses the possible role for mineralocorticoid receptor in the pathogenesis of cardiovascular and renovascular injury in diabetes mellitus. Recent findings Mineralocorticoid receptor activation has multiple adverse effects on the cardiovascular system, including the promotion of vascular injury and inflammation, atherosclerosis, myocardial necrosis and inflammation, cardiac fibrosis and remodeling, renal injury, proteinuria, stroke and hypertension. Studies examining these effects of mineralocorticoid receptor have focused on patients with cardiac dysfunction and on non-diabetic animal models of cardiovascular and renovascular injury. Diabetic individuals with heart failure show a beneficial response to mineralocorticoid receptor antagonists. Mineralocorticoid receptor antagonists also reduce proteinuria in patients with diabetes, and reduce renal injury in diabetic animal models. Mineralocorticoid receptor antagonists may, however, have adverse effects in diabetes, including the induction of hyperkalemia, endothelial dysfunction and autonomic dysfunction. Summary There is strong evidence that mineralocorticoid receptor activation contributes to the pathophysiology of cardiovascular and renovascular injury, although few studies have shown these effects in diabetic populations. There is thus a need for large-scale prospective studies to determine the role of mineralocorticoid receptor antagonists in the treatment of patients with diabetes.