Use of ACE Inhibitors to Reduce Mortality in Patients With Type 2 Diabetes

The use of ACE inhibitor therapy in the early treatment of type 2 diabetes is associated with reduced risk of mortality. The majority of deaths in patients with type 2 diabetes are due to the macrovascular complications of cardiovascular disease (CVD) and stroke. ACE inhibitor therapy is widely used in patients with type 2 diabetes to lower mortality risk, but there is limited direct clinical evidence to support this treatment.

Eurich and colleagues conducted an observational study to test the hypothesis that ACE inhibitor use would be associated with reduced mortality in patients with newly diagnosed type 2 diabetes but without clinical CVD.

The authors selected from a pool of 12,272 first-time users of oral hypoglycemic agents (metformin or a sulfonylurea) who Continued were registered beneficiaries with Saskatchewan Health, the universal health plan for that Canadian province, between 1991 and 1996.
Subjects with established CVD diagnoses or previous use of ACE inhibitors were excluded, leaving 6,176 patients. Mean age for all subjects was 60.7 years; 43.6% were women.

The subjects were then divided into those who used ACE inhibitors for more than 1 year between 1991 and 1996 (n=1,187) and a control cohort that did not use ACE inhibitors during that time (n=4,989). Mean duration of ACE inhibitor therapy was 3.6 years. Mean duration of follow-up was 5.3 years. Primary outcomes were all cause and CV-related mortality.

By end of study there were 853 (17.1%) deaths in the control group compared with 102 (8.6%) in the ACE inhibitor group (P<0.001). Of these, 261 (5.2%) CV-related deaths occurred in the control group and 40 (3.4%) in the ACE inhibitor group (P=0.007). The adjusted hazard ratios for all-cause and CV-related mortality were 0.49 (0.40-0.61, P<0.001) and 0.63 (0.44-0.90, P=0.012), respectively.

The authors concluded that the use of ACE inhibitor therapy in the early treatment of type 2 diabetes is associated with a reduced risk of all-cause and CV mortality.

Diabetes Care. 2004;27:1330-1334.
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DID YOU KNOW: Regular exercise can reduce the risk of chronic disease — such as heart trouble, diabetes, even cancer — and keep you feeling and looking younger as you age. While the message is clear, it’s not getting through to the majority of older Americans. Only 11% of people aged 65 or older responding to a government survey earlier this year said they engaged in strength training two or more days each week, the recommended level to improve overall health and fitness.
U.S. Centers for Disease Control and Prevention

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