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Ramipril and the Development of Diabetes
Open accessAbstract
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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Metadata
- 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
- 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
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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