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ACE Inhibitors Cut Risk Of Death In Half For Those
With Diabetes
posted 06/03/04
People with newly diagnosed type 2 diabetes could improve
their odds of living longer and improve their heart health by taking these
drugs, known as ACE inhibitors, a new study shows.
ACE inhibitors -- or angiotensin-converting enzyme inhibitors -- are used to
treat high blood pressure. The drugs work by interfering with the formation of a
hormone that can narrow blood vessels and increase blood pressure. Some examples
of these medications include the drugs such as Accupril, Monopril, Vasotec, and
Zestril.
While blood pressure control is important in diabetes, there's also evidence
that these drugs protect the kidneys from damage -- another serious complication
that results from uncontrolled diabetes, he explains.
People with diabetes are at higher risk for heart disease and early death. But
in his study of newly diagnosed people, he shows that these drugs can decrease
the risk of death even in people without pre-existing heart disease.
Johnson's study is the first to investigate -- in a large population -- the
heart-health benefits of these drugs in people with diabetes.
His finding: ACE inhibitors cut the risk of death in half, he reports. Also, the
drugs reduced the risk of death from heart disease by 23%. "ACE inhibitors
reduce [death] risk, whether there is heart disease or not," says Johnson.
In his study, Johnson and his colleagues analyzed nearly five years worth of
medical records of people with newly diagnosed diabetes -- almost 1,200 "new
users" of ACE inhibitors and almost 5,000 people with type 2 diabetics not
taking ACE inhibitors. The volunteers were men and women whose average age was
61 years old.
During the five-year study, researchers found significantly fewer deaths in the
people with type 2 diabetes on ACE inhibitors:
*** 9% of the ACE inhibitor group died, compared with 17% of those not taking
the medication.
*** Of those deaths, only 3% in the ACE inhibitor group were related to heart
disease, compared with 5% in the comparison group.
*** Previous research has demonstrated that ACE inhibitors improve
cardiovascular and renal outcomes in a generalized cohort of patients with type
2 diabetes.
*** Recent data show that ACE inhibitors reduce all-cause and cardiovascular
mortality in newly treated patients with type 2 diabetes.
Source: Diabetes In Control.com: Diabetes Care.
2004;27:1330-1334.
Donald G. Vidt, MD, consultant in the department of nephrology and hypertension
for The Cleveland Clinic Foundation, offered his opinion of the findings.
Johnson's study helps back up what doctors have long suspected -- that ACE
inhibitors have an effect independent of heart disease, Vidt explains. "It would
appear that use of ACE inhibitors significantly reduces risk of early death.
This is a big issue because we don't necessarily recommend starting ACE
inhibitors in every [patient with type 2 diabetes]. But this study suggests we
need to look again at this issue. There may be benefit to starting patients on
these drugs very early."
Another class of high blood pressure medications, called angiotensin receptor
blockers, can be substituted for people who can't tolerate ACE inhibitors, Vidt
says. Examples of these drugs include Avapro, Cozaar, and Diovan.
Source: Diabetes In Control.com: Diabetes Care June 2004.
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