Role of the Renin-Angiotensin system and aldosterone on cardiometabolic syndrome.

Aldosterone facilitates cardiovascular damage by increasing blood pressure and through different mechanisms that are independent of its effects on blood pressure. In this respect, recent evidence involves aldosterone in the pathogenesis of metabolic syndrome. Although this relationship is complex, there is some evidence suggesting that different factors may play an important role, such as insulin resistance, renin-angiotensin-aldosterone system, oxidative stress, sodium retention, increased sympathetic activity, levels of free fatty acids, or inflammatory cytokines and adipokines. In addition to the classical pathway by which aldosterone acts through the mineralocorticoid receptors leading to sodium retention, aldosterone also has other mechanisms that influence cardiovascular tissue remodelling. Finally, overweight and obesity promote the adrenal secretion of aldosterone, increasing the predisposition to type 2 diabetes mellitus. Further studies are needed to better establish therapeutic strategies that act on the blockade of mineralocorticoid receptor in the treatment and prevention of cardiovascular diseases related to the excess of aldosterone and the metabolic syndrome.

The HELLP syndrome (hemolysis, elevated liver enzymes and low platelets): Clinical characteristics and maternal-fetal outcome in 172 patients.

OBJECTIVES: To analyze the frequency of the different clinical presentations of the disease in women with HELLP syndrome and the most important factors that can predict a different maternal and fetal outcome. STUDY DESIGN: This is a cross-sectional, consecutive, case-series study, the subjects being all patients with HELLP syndrome admitted to our Hospital within the last decade (1999-2009). RESULTS: The rate of maternal complications was 43.0% and perinatal mortality 14.1%. The severity of the syndrome, measured by The Mississippi Classification, influenced the rate of maternal complications but not fetal mortality: the rate of maternal complications among women in class 1 HELLP syndrome was 67.6%, compared to 49.3% in class 2 and 24.0% in class 3 HELLP syndrome, p<0.0001. In a 21.8% of women, the onset of the disease was after delivery. We highlight the fact that those cases with an early puerperium onset of the disease were those with a higher number of maternal complications (odds ratio: 2.38; CI: 1.05-5.44). CONCLUSIONS: These results suggest the possibility of an increased complication rate when the onset of the syndrome appears after delivery and the necessity of having a high grade of suspicion in every case to diagnose the disease, even when the gestation and delivery were normal.