Mineralocorticoid Receptor Blockade Improves Coronary Microvascular Function in Individuals with Type 2 Diabetes Mellitus.

Mineralocorticoid Receptor Blockade Improves Coronary Microvascular Function in Individuals with Type 2 Diabetes Mellitus. Diabetes. 2014 Aug 14; Authors: Garg R, Rao AD, Baimas-George M, Hurwitz S, Foster C, Shah RV, Jerosch-Herold M, Kwong RY, Di Carli MF, Adler GK Abstract Reduced coronary flow reserve (CFR), an indicator of coronary microvascular dysfunction, is seen in type 2 diabetes mellitus (T2DM) and predicts cardiac mortality. Since aldosterone plays a key role in vascular injury, the aim of this study was to determine whether mineralocorticoid receptor (MR) blockade improves CFR in individuals with T2DM. Sixty-four men and women with well-controlled diabetes on chronic angiotensin converting enzyme inhibition (enalapril 20 mg/day) were randomized to add-on therapy of spironolactone 25mg, hydrochlorothiazide (HCTZ) 12.5mg, or placebo for 6 months. CFR was assessed by cardiac positron emission tomography (PET) at baseline and at the end of treatment. There were significant and similar decreases in systolic blood pressure with spironolactone and HCTZ but not with placebo. CFR improved with treatment in the spironolactone group as compared with the HCTZ group and with the combined HCTZ and placebo groups. The increase in CFR with spironolactone remained significant after controlling for baseline CFR, change in BMI, race and statin use. Treatment with spironolactone improved coronary microvascular function raising the possibili...
Source: Diabetes - Category: Endocrinology Authors: Tags: Diabetes Source Type: research