HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Appendix Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Eurich, D. T. Articles by Johnson, J. A. Search for Related Content PubMed PubMed Citation Articles by Eurich, D. T. Articles by Johnson, J. A. Social Bookmarking                What's this?

Reduced Mortality Associated With the Use of ACE Inhibitors in Patients With Type 2 Diabetes

¹ Institute of Health Economics, Edmonton, Alberta, Canada
² Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
³ Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
⁴ Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

Address correspondence and reprint requests to Dr. Jeffrey A. Johnson, #1200, 10405 Jasper Ave., Edmonton, AB, Canada T5J 3N4. E-mail: jeff.johnson{at}ualberta.ca

OBJECTIVE—ACE inhibitor therapy is widely used in lower-risk patients with type 2 diabetes to reduce mortality, despite limited evidence to support this clinical strategy. The aim of this study was to evaluate the association between ACE inhibitor use and mortality in patients with diabetes and no cardiovascular disease.

RESEARCH DESIGN AND SETTINGS—Using the Saskatchewan health databases, 12,272 new users of oral hypoglycemic agents were identified between the years of 1991 and 1996. We excluded 3,202 subjects with previous cardiovascular disease. Of the remaining subjects, 1,187 "new users" of ACE inhibitors were identified (ACE inhibitor cohort). Subjects not receiving ACE inhibitor therapy throughout the follow-up period served as the control cohort (n = 4,989). Subjects were prospectively followed until death or the end of 1999. Multivariate Cox proportional hazards models were used to assess differences in all-cause and cardiovascular-related mortality between cohort groups.

RESULTS—Subjects were 60.7 ± 13.7 years old, 43.6% female, and were followed for an average of 5.3 ± 2.1 years. Mean duration of ACE inhibitor therapy was 3.6 ± 1.8 years. We observed significantly fewer deaths in the ACE inhibitor group (102 [8.6%]) compared with the control cohort (853 [17.1%]), with an adjusted hazard ratio (HR) and 95% CI of 0.49 (0.40–0.61) (P < 0.001). Cardiovascular-related mortality was also reduced (40 [3.4%] vs. 261 [5.2%], adjusted HR, 0.63 [0.44–0.90]; P = 0.012).

CONCLUSIONS—The use of ACE inhibitors was associated with a significant reduction in all-cause and cardiovascular-related mortality in a broad spectrum of patients with type 2 diabetes and no cardiovascular disease.

Abbreviations: CDS, Chronic Disease Score • HOPE, Heart Outcomes Prevention Evaluation

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				J. D. Piette Interactive Behavior Change Technology to Support Diabetes Self-Management: Where do we stand? Diabetes Care, October 1, 2007; 30(10): 2425 - 2432. [Full Text] [PDF]

				S. L. Maddigan, D. H. Feeny, S. R. Majumdar, K. B. Farris, and J. A. Johnson Understanding the Determinants of Health for People With Type 2 Diabetes Am J Public Health, September 1, 2006; 96(9): 1649 - 1655. [Abstract] [Full Text] [PDF]

				J. D. Piette and E. A. Kerr The impact of comorbid chronic conditions on diabetes care. Diabetes Care, March 1, 2006; 29(3): 725 - 731. [Full Text] [PDF]

				P. De, G. Das, K. Harley, and H. Nair Review: Dual blockade of renin-angiotensin system in diabetic nephropathy: review of literature and local experience The British Journal of Diabetes & Vascular Disease, January 1, 2006; 6(1): 23 - 28. [Abstract] [PDF]

				D. T. Eurich, S. R. Majumdar, F. A. McAlister, R. T. Tsuyuki, and J. A. Johnson Improved Clinical Outcomes Associated With Metformin in Patients With Diabetes and Heart Failure Diabetes Care, October 1, 2005; 28(10): 2345 - 2351. [Abstract] [Full Text] [PDF]

				C. G. McDonald, S. R. Majumdar, J. L. Mahon, and J. A. Johnson The Effectiveness of {beta}-Blockers After Myocardial Infarction in Patients With Type 2 Diabetes Diabetes Care, September 1, 2005; 28(9): 2113 - 2117. [Abstract] [Full Text] [PDF]

				P. Ruggenenti, A. Fassi, A. P. Ilieva, S. Bruno, I. P. Iliev, V. Brusegan, N. Rubis, G. Gherardi, F. Arnoldi, M. Ganeva, et al. Preventing Microalbuminuria in Type 2 Diabetes N. Engl. J. Med., November 4, 2004; 351(19): 1941 - 1951. [Abstract] [Full Text] [PDF]