Session Speaker

Renin Angotensin System – A Therapeutic Target for Ischemic Heart Disease
T.S. Mohamed Saleem

Cardiovascular disease is the leading cause of death in western societies, with myocardial infarction as the primary assassin. Heart diseases have no geographical, gender or socio-economical boundaries. At present, cardiovascular diseases represent the most important health risks because they are responsible for more than 50% of total mortality. Among them, ischemic heart disease is the leading cause of morbidity and mortality, and according to the World Health Organization, will be the major global cause of death by the year 2020. Ischemic heart disease characterized by endothelial dysfunction, a pro-inflammatory state and often also by extensive vascular remodeling. Ang II, the main peptide of the RAS, participates in the pathogenesis of several cardiovascular diseases. Ang II is not only a potent vasoconstrictor which elevates arterial blood pressure, but also a powerful pro-inflammatory cytokine, chemokine and growth factor. There is accumulating evidence that Ang II can cause target organ damage by facilitating inflammatory and growth responses through activation of NFκB, the key nuclear transcription factor in inflammatory and fibrotic diseases. Improved outcomes in clinical trials have emphasized the importance of RAS blockade in these diseases, showing beneficial organ protective effects beyond blood pressure reduction. Blockade of RAS with effective drugs will provide protection against IHD through inhibition of Ang II production. Although ARBs and ACE inhibitors are now widely used for protection against organ damage in hypertensive and diabetic patients. But, these drugs completely block the production and actions of Ang II remain unclear. Many of the ongoing trails evaluate the effect of these drugs with Monotherapy and combined therapy in ischemic heart disease. Recently developed direct renin inhibitor aliskiren inhibit the formation of Ang II and still research is undergone with aliskiren. Moreover the molecular functional aspects of these drugs in RAAS system remain unclear and need to be investigated. If we are targeting renin angiotensin system by using existing and newer drugs will provide novel therapeutic potential for ischemic heart disease.