Effect of ramipril on the incidence of diabetes
Copyright © 2006 Massachusetts Medical Society. All rights reserved. Background: Previous studies have suggested that blockade of the renin-angiotensin system may prevent diabetes in people with cardiovascular disease or hypertension. Methods: In a double-blind, randomized clinical trial with a 2-by-2 factorial design, we randomly assigned 5269 participants without cardiovascular disease but with impaired fasting glucose levels (after an 8-hour fast) or impaired glucose tolerance to receive ramipril (up to 15 mg per day) or placebo (and rosiglitazone or placebo) and followed them for a median of 3 years. We studied the effects of ramipril on the development of diabetes or death, whichever came first (the primary outcome), and on secondary outcomes, including regression to normoglycemia. Results: The incidence of the primary outcome did not differ significantly between the ramipril group (18.1%) and the placebo group (19.5%; hazard ratio for the ramipril group, 0.91; 95% confidence interval [CI], 0.81 to 1.03; P = 0.15). Participants receiving ramipril were more likely to have regression to normoglycemia than those receiving placebo (hazard ratio, 1.16; 95% CI, 1.07 to 1.27; P = 0.001). At the end of the study, the median fasting plasma glucose level was not significantly lower in the ramipril group (102.7 mg per deciliter [5.70 mmol per liter]) than in the placebo group (103.4 mg per deciliter [5.74 mmol per liter], P = 0.07), though plasma glucose levels 2 hours after an oral glucose load were significantly lower in the ramipril group (135.1 mg per deciliter [7.50 mmol per liter] vs. 140.5 mg per deciliter [7.80 mmol per liter], P = 0.01). Conclusions: Among persons with impaired fasting glucose levels or impaired glucose tolerance, the use of ramipril for 3 years does not significantly reduce the incidence of diabetes or death but does significantly increase regression to normoglycemia.
Bosch, J; Yusuf, S; Gerstein, HC; Pogue, J; Sheridan, P; Dagenais, G; Chiasson, JL; Diaz, R; Avezum, A; Lanas, F; Probstfield, J; Fodor, G; Holman, RR; Anand, S; Budaj, A; Conget, I; Davis, M; Dinccag, N; Enjalbert, M; Escalante, A; Hanefeld, M; Hedner, T; Jolly, K; Keltai, M; Laakso, M; Lonn, E; McQueen, M; Mohan, V; Phillips, A; Piegas, L; Pirags, V; Schmid, I; Shaw, J; Teo, K; Zimmet, P; Zinman, B; Ahuad Guerrero, R; Albisu, J; Alvarez, MS; Arregui, V; Avaca, H; Baglivo, H; Balbuena, M; Bello, F; Bono, J; Botto, M; Brandani, L; Brandes, M; Bruera, D; Cabral Venere, R; Caccavo, A; Cacurri, A; Caime, G; Capozzi, M; Carrique, A; Carrique, P; Cartasegna, L; Casabe, J; Casaccia, G; Castellanos, C; Castro, L; Cendali, G; Cerchi, P; Cerdan, M; Cinalli, M; Cipullo, M; Cismondi, M; Citta, N; Citta, L; Crespo, C; Crunger, P; Cuneo, C; De Loredo, L; De Loredo, S; Del Cerro, S; Denaro, R; Esperatti, E; Esposito, L; Farras, H; Fernandez, S; Fernandez, M; Fernandez, A; Ferrari, G; Focaccia, M; Frontini, L; Gabito, A; Gambarte, A; Garrido, M
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