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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.

References

• Lewis EJ, Hunsickler LG, Bain RP, Rohde RD The effect of angiotensin-converting enzyme inhibition on diabetic nephropathy. N Engl J Med 1993;329:1456-62.[Abstract/Free Full Text]
• The EUCLID Study Group. Randomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria. Lancet 1997;349:1787-92.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Chaturvedi N., Sijolie AK, Stephenson JM et al. and the EUCLID Study Group. Effect of lisinopril on progression of retinopathy in normotensive people with Type 1 diabetes. Lancet 1998;351:28-31.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• GISSI-3 study group. Effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction. Lancet 1994;343:115-22.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Shindler DM, Kostis JB, Yusuf S. et al. Diabetes mellitus, a predictor of morbidity and mortality in the Studies of Left Ventricular Dysfunction (SOLVD) Trials and Registry. Am J Cardiology 1996;77:1017-20.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Roper NA, Bilous RW, Kelly WF, Unwin NC, Connolly VM Excess mortality in a population with diabetes and the impact of material deprivation: longitudinal, population based study. BMJ 2001;7299:1389-92.
• Haffner SM, Lehto S., Rönnemaa T. et al. Kaplan-Meier estimates of the probability of death from coronary heart disease in subjects who had not had a previous myocardial infarction. N Engl J Med 1998;339:229-34.[Abstract/Free Full Text]
• The Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000;342:145-53.[Abstract/Free Full Text]
• The Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet 2000;355:253-9.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Pyorali K., Pedersen TR, Kjekshus J., Faergeman O., Olsson AG, Thorgeirsson G. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. Diabetes care 1997;20:614-20.[Abstract]
• UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ 1998;317:703-13.[Abstract/Free Full Text]
• Hansson L., Lindholm LH, Niskanen L. et al. Effect of ACE-inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet 1999;353:611-16.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 39). BMJ 1998;317:713-20.[Abstract/Free Full Text]
• Patel V., Rassam SMB, Chen HC, Kohner EM Effect of angiotensin-converting enzyme inhibition with perindopril and -blockade with atenolol on retinal blood flow in hypertensive diabetic subjects. Metabolism 1998;47(Supp 1):28-33.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837-53.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998;352:854-65.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Stratton IM, Cull CA, Manley SE et al. Relation between diabetes and hyperglycaemia and cardiovascular disease has not been resolved (authors reply). BMJ 2001;322:1247.[Free Full Text]
• Miles Fisher B. Results of the Heart Outcomes Prevention Evaluation (HOPE) Study: Implications for the care of people with diabetes. Modern Diabetes Management 2000;1:2-5.
• Malmberg K. Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. BMJ 1997;314:1512-15.[Abstract/Free Full Text]
• Aspirin and diabetes (Fact sheet 21). Diabetes Update, Diabetes UK Summer 2001.

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


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