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J Am Coll Cardiol, 2005; 46:821-826, doi:10.1016/j.jacc.2005.05.051 (Published online 9 August 2005).
© 2005 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: DIABETES AND CARDIOVASCULAR DISEASE

Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers for Prevention of Type 2 Diabetes

A Meta-Analysis of Randomized Clinical Trials

Hussam Abuissa, MD*, Philip G. Jones, MS, Steven P. Marso, MD and James H. O’Keefe, Jr, MD

Mid America Heart Institute, Cardiovascular Consultants, Kansas City, Missouri

Manuscript received December 27, 2004; revised manuscript received April 28, 2005, accepted May 10, 2005.

* Reprint requests and correspondence: Dr. Hussam Abuissa, Mid America Heart Institute, Cardiovascular Consultants, 4330 Wornall Road, Suite 2000, Kansas City, Missouri 64111 (Email: abuissah{at}umkc.edu).

OBJECTIVES: We sought to investigate the role of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in preventing the new onset of type 2 diabetes mellitus.

BACKGROUND: Diabetes is a public health problem of epidemic proportions and its prevalence is on the rise. The typical American born today has a one in three chance of developing type 2 diabetes. This diagnosis is associated with an adverse cardiovascular prognosis and is considered the risk equivalent of established coronary disease. Even in high-risk individuals, diabetes is a preventable disease. Several studies have shown that ACE inhibitors and ARBs decrease the incidence of new-onset type 2 diabetes. However, the exact role of these agents in diabetes prevention has not yet been fully elucidated.

METHODS: We conducted a meta-analysis of 12 randomized controlled clinical trials of ACE inhibitors or ARBs, identified through a MEDLINE search and a review of reports from scientific meetings, to study the efficacy of these medications in diabetes prevention.

RESULTS: This showed that ACE inhibitors and ARBs were associated with reductions in the incidence of newly diagnosed diabetes by 27% and 23%, respectively, and by 25% in the pooled analysis.

CONCLUSIONS: The use of an ACE inhibitor or ARB should be considered in patients with pre-diabetic conditions such as metabolic syndrome, hypertension, impaired fasting glucose, family history of diabetes, obesity, congestive heart failure, or coronary heart disease.

Abbreviations and Acronyms
  ACE = angiotensin-converting enzyme
  ARB = angiotensin receptor blocker
  PPAR = peroxisome proliferator-activated receptor
  RAAS = renin angiotensin aldosterone system




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