Diabetes Metab Res Rev 2002; 18: S82-S85. "Reduction of cardiovascular events and microvascular complications in diabetes with ACE inhibitor treatment: HOPE and MICRO-HOPE"
10/30/2002 09:30:18 AM
By Andrew A. Skolnick
Treatment with the ACE inhibitor ramipril may help prevent the development of diabetes as well as lower the risk of heart attack, stroke, and cardiovascular mortality in patients at high risk for cardiovascular events.
Dr. Hertzel C. Gerstein, at the McMaster University Medical Center, in Hamilton, Ontario, Canada, evaluated the effects of ramipril on patients at high risk for cardiovascular events, who took part in the Heart Outcomes Prevention Evaluation (HOPE) trial. The study included 9,541 patients in the arms comparing ramipril with placebo, 3,577 of whom had diabetes. The patients who were randomly assigned to receive either ramipril (10 mg) or placebo, were followed-up for a median of 4.5 years. Compared with patients receiving placebo, there was a significant 25 percent reduction in the risk for the composite endpoint of myocardial infarction, stroke or cardiovascular death among patients receiving ramipril.
This reduction was independent of any blood pressure-lowering effect, Dr. Gerstein reported. In addition, a substudy of this patient population (called the Microalbuminuria, Cardiovascular, and Renal Outcomes in HOPE [MICRO-HOPE] substudy), showed that ramipril treatment was associated with a decreased risk of development of overt nephropathy.
The use of a composite measure of microvascular complications also suggested a protective effect of ramipril treatment, he said. "An interesting finding in the HOPE study is that ramipril treatment was associated with a significant 34 percent reduction in new diagnoses of diabetes," Dr. Gerstein wrote. "The possibility that ACE inhibitor treatment with ramipril may prevent new diabetes in non-diabetic patients at high risk of the disease is to be examined prospectively in the Diabetes Reduction Assessment with ramipril and rosiglitazone (DREAM) trial."