Reported data shows that angiotensin II (Ang II) produces apoptosis and necrosis of myocytes (Circ Res 2000;87:1123-32). Endothelin I (EL) also produces myocardial necrosis. To establish an association between these hormones and coronary disease, we determined the levels of Ang II and E1 in the coronary sinus (CS) and peripheral circulation of diabetic patients. The levels of Ang II in the CS and aorta were elevated (46 ± 18 vs 35 ± 15 pg/mL, respectively) compared to normals (10 pg/mL, p < .001). Similarly, El was elevated in the CS and aorta (14 ± 4 and 13 ± 6 pg/mL, respectively, vs. 3 ± 1 pg/mL in control patients, p < .001). The ejection fraction of diabetics was subnormal 49 ± 3%, when compared to controls (62 ± 5%), and diffuse hypokinesis was observed. These results support the notion that Ang II and El play a role in the development of cardiomyopathy in diabetic patients. Blockers of these peptides may help in the prevention of this cardiovascular condition.
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