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Tissue angiotensin‐converting enzyme inhibitors for the prevention of cardiovascular disease in patients with diabetes mellitus without left ventricular systolic dysfunction or clinical evidence of heart failure: a pooled meta‐analysis of randomized placebo‐controlled clinical trials
Author(s) -
Saha S. A.,
Molnar J.,
Arora R. R.
Publication year - 2008
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/j.1463-1326.2006.00688.x
Subject(s) - medicine , heart failure , diabetes mellitus , myocardial infarction , cardiology , placebo , meta analysis , randomized controlled trial , relative risk , angiotensin converting enzyme , clinical trial , stroke (engine) , blood pressure , confidence interval , endocrinology , pathology , mechanical engineering , alternative medicine , engineering
Aim: The aim of this study was to determine the role of tissue angiotensin‐converting enzyme (ACE) inhibitors in the prevention of cardiovascular disease in patients with diabetes mellitus without left ventricular systolic dysfunction or clinical evidence of heart failure in randomized placebo‐controlled clinical trials using pooled meta‐analysis techniques. Methods: Randomized placebo‐controlled clinical trials of at least 12 months duration in patients with diabetes mellitus without left ventricular systolic dysfunction or heart failure who had experienced a prior cardiovascular event or were at high cardiovascular risk were selected. A total of 10 328 patients (43 517 patient‐years) from four selected trials were used for meta‐analysis. Relative risk estimations were made using data pooled from the selected trials and statistical significance was determined using the Chi‐squared test (two‐sided alpha error <0.05). The number of patients needed to treat was also calculated. Results: Tissue ACE inhibitors significantly reduced the risk of cardiovascular mortality by 14.9% (p = 0.022), myocardial infarction by 20.8% (p = 0.002) and the need for invasive coronary revascularization by 14% (p = 0.015) when compared to placebo. The risk of all‐cause mortality also tended to be lower among patients randomized to tissue ACE inhibitors, whereas the risks of stroke and hospitalization for heart failure were not significantly affected. Treating about 65 patients with tissue ACE inhibitors for about 4.2 years would prevent one myocardial infarction, whereas treating about 85 patients would prevent one cardiovascular death. Conclusion: Pooled meta‐analysis of randomized placebo‐controlled trials suggests that tissue ACE inhibitors modestly reduce the risk of myocardial infarction and cardiovascular death and tend to reduce overall mortality in diabetic patients without left ventricular systolic dysfunction or heart failure.