Ramipril and the development of diabetes

Context Type 2 diabetes is a growing clinical and public health problem. Pr eventive efforts related to lifestyle modification are not always successfu l; therefore, alternative prevention strategies need to be studied. Objective To investigate the effectiveness of ramipril, an angiotensin-conv erting-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 k nown 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 conduct ed 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 f ollow-up visits every 6 months, compared between the 2 groups. Results one hundred and two individuals (3.6%) in the ramipril group develo ped 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 result s were noted when different diagnostic criteria were used; in the ramipril group, the RR for diagnosis of diabetes and hemoglobin A(1c) greater than 1 10% was 0.60 (95% Cl, 0.43-0.85), for initiation of glucose-lowering therap y, 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 dia betes in high-risk individuals. Because these results have important clinic al and public health implications, this hypothesis requires prospective con firmation.