This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Patel, V. Articles by Venkataraman, A. Search for Related Content Social Bookmarking                         What's this?

The HOPE Study and MICRO-HOPE Substudy

effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus

Diabetes and Endocrinology Centre, Eliot Hospital NHS Trust, vinod.patel{at}geh-tr.wmids.nhs.uk

Srinivas Panja

Diabetes and Endocrinology Centre, Eliot Hospital NHS Trust

Asok Venkataraman

Coronary Care Unit, George Eliot Hospital NHS Trust, Nuneaton, UK

Background

ACE inhibitors have a special role in diabetes care. They have been proven to reduce urinary albumin excretion and reduce the rate of progression of diabetic nephropathy and retinopathy. ^1-3 There is proven benefit post myocardial infarction, with a greater beneficial effect in patients with diabetes in comparison to those without. ⁴ The effect of ACE inhibitors in patients who have low ejection fractions or overt cardiac failure is well described.⁵ More recent studies indicate other benefits of ACE inhibitors such as improving dyslipidaemia and insulin sensitivity.

Cardiovascular disease is the commonest cause of mortality among patients with type 2 diabetes. A recent study reports the standardised mortality ratio to be considerably higher in people with diabetes with the vast majority of the excess due to cardiovascular disease (type 1 diabetes: women x 6.41, men x 2.94, type 2 diabetes: women x 1.6, men x 1.41).⁶ Patients with type 2 diabetes who have no evidence of previous coronary heart disease were found to be at the same risk of myocardial infarction and cardiovascular death as non-diabetic patients who had already suffered from a myocardial infarction.⁷

The diabetes subject cohort of the HOPE Study, (Heart Outcomes Prevention Evaluation Study), sought to investigate whether ACE inhibitor treatment with ramipril in high-risk patients with diabetes lowers the risk of cardiovascular events.⁸ Within this main study the MICRO-HOPE substudy investigated the effect of ACE inhibitor treatment with ramipril on microalbuminuria and diabetic retinopathy. ⁹ The aim of this article is to offer a clinical summary of the above studies and suggest recommendations for clinical practice.

Key Words: diabetes • cardiovascular disease • microvascular complications • HOPE study • ACE inhibitor.

The British Journal of Diabetes & Vascular Disease, Vol. 1, No. 1, 44-51 (2001)
DOI: 10.1177/14746514010010010701


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

This article has been cited by other articles:

				P. A Henriksen, K A. Lockman, S. J Robertson, D. Clark, J. I. Barclay, J. Chalmers, and I. W Campbell Audit of cardiovascular risk assessment in type 2 diabetic patients referred for insulin therapy: a cardiological perspective The British Journal of Diabetes & Vascular Disease, January 1, 2004; 4(1): 34 - 38. [Abstract] [PDF]