Cited by 541Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and ManagementBlood Pressure and Hypertension Studies

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Ramipril and the Development of Diabetes

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Yusuf, Salim·2001·JAMA

DOI 10.1001/jama.286.15.1882

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Abstract

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.

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Authors: Yusuf, S.
Affiliations: Hamilton General Hospital (CA)
Corresponding author: Yusuf, Salim
ORCID: Yusuf, Salim
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2001-10-17
Volume: 286
Issue: 15
Pages: 1882
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.286.15.1882
OpenAlex: W1980567021
Cited by: 541
References: 15
Citations by year: 2026: 3 · 2025: 1 · 2024: 10 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 4 · 2019: 7 · 2018: 4 · 2017: 12 · 2016: 5 · 2015: 12 · 2014: 10 · 2013: 15 · 2012: 21
FWCI: 33.55
Type: journal article
Language: en
Open access: green
cris.maastrichtuniversity.nl
Licence: other-oa
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Research Publications (Maastricht University) (submittedVersion, other-oa)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords: ramipril, type 2 diabetes prevention, ACE inhibitors, diabetes incidence, high-risk patients, vascular disease, older adults, glucose-lowering therapy, HbA1c
MeSH terms: Aged, Angiotensin-Converting Enzyme Inhibitors, Cardiovascular Diseases, Diabetes Mellitus, Female, Humans, Male, Middle Aged, Proportional Hazards Models, Survival Analysis, Randomized Controlled Trials as Topic, Ramipril

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