Management of Cardiorenal Metabolic Syndrome in Diabetes Mellitus: A Phytotherapeutic Perspective
The cardiorenal syndrome in patients with diabetes mellitus represents a systemic condition that affects both the cardiovascular and renal systems. Diabetes is a well established risk factor for cardiovascular disease (CVD), and a significant proportion of diabetic patients go on to develop clinically significant nephropathy. In the diabetic state the kidney is involved by progressive sclerosis/fibrosis and proteinuria, due most likely to overactivity of the transforming growth factor-beta system and, to some extent, the vascular endothelial growth factor system, respectively. The pathogenesis of CVD in diabetes is multifactorial, involving hemodynamic forces, humoral/metabolic factors, and oxidative stress. Additionally, it has been suggested that endothelial dysfunction may lead to simultaneous development and progression of renal and cardiac pathology in diabetes. The risk of microvascular complications can be reduced by intensive glycemic control in patients with type 1 and type 2 diabetes mellitus whereas benefit to the cardiovascular system is less clear. However, intensified intervention involving other CVD risk factors like hypertension and dyslepidemia and interception of the rennin-angiotensin-aldosterone system in patients with type 2 diabetes have been shown to be associated with significant reduction in the risk for renal disease progression that was paralleled by a significant reduction in cardiovascular disease burden.