Ramipril reduced the development of diabetes compared to placebo in high-risk patients with vascular disease (3.6% vs 5.4%; RR 0.66; 95% CI 0.51-0.85; P<.001).
RCT (n=5,720)
randomly assigned
Yes
Does ramipril prevent diabetes in patients older than 55 years without known diabetes but with vascular disease?
Ramipril significantly reduces the incidence of new-onset diabetes in high-risk patients with vascular disease.
Relative Risk: 0.66 (95% CI 0.51–0.85)
Absolute Event Rate: 3.6% vs 5.4%
p-value: p=<.001
CONTEXT: Type 2 diabetes is a growing clinical and public health problem. Preventive efforts related to lifestyle modification are not always successful; therefore, alternative prevention strategies need to be studied. OBJECTIVE: To investigate the effectiveness of ramipril, an angiotensin-converting enzyme inhibitor, in preventing diabetes among high-risk persons. DESIGN, SETTING, AND PARTICIPANTS: The randomized, controlled Heart Outcomes Prevention Evaluation trial of 5720 patients older than 55 years without known diabetes but with vascular disease who were followed up for a mean of 4.5 years. The study included 267 hospitals in 19 countries and was conducted between 1994 and 1999. INTERVENTION: Patients were randomly assigned to receive ramipril, up to 10 mg/d (n = 2837), or placebo (n = 2883). MAIN OUTCOME MEASURE: Diagnosis of diabetes determined from self-report at follow-up visits every 6 months, compared between the 2 groups. RESULTS: One hundred and two individuals (3.6%) in the ramipril group developed diabetes compared with 155 (5.4%) in the placebo group (relative risk RR, 0.66; 95% confidence interval CI, 0.51-0.85, P<.001). Similar results were noted when different diagnostic criteria were used; in the ramipril group, the RR for diagnosis of diabetes and hemoglobin A(1c) greater than 110% was 0.60 (95% CI, 0.43-0.85), for initiation of glucose-lowering therapy, 0.56 (95% CI, 0.41-0.77), and for both, 0.51 (95% CI, 0.34-0.76). These effects were also consistently seen in several subgroups examined. CONCLUSIONS: Ramipril is associated with lower rates of new diagnosis of diabetes in high-risk individuals. Because these results have important clinical and public health implications, this hypothesis requires prospective confirmation.
Salim Yusuf (Wed,) conducted a rct in High-risk persons without known diabetes but with vascular disease (n=5,720). Ramipril vs. Placebo was evaluated on Diagnosis of diabetes determined from self-report (RR 0.66, 95% CI 0.51-0.85, p=<.001). Ramipril reduced the development of diabetes compared to placebo in high-risk patients with vascular disease (3.6% vs 5.4%; RR 0.66; 95% CI 0.51-0.85; P<.001).