Effects of renin–angiotensin system blockades on cardiovascular outcomes in patients with diabetes mellitus: A systematic review and meta-analysis

Nakao, Yoko M.; Teramukai, Satoshi; Tanaka, Sachiko; Yasuno, Shinji; Fujimoto, Akira; Kasahara, Masato; Ueshima, Kenji; Nakao, Kazuhiro; Hinotsu, Shiro; Nakao, Kazuwa; Kawakami, Koji

doi:10.1016/j.diabres.2011.11.025

« Previous Next »Diabetes Research and Clinical Practice
Volume 96, Issue 1 , Pages 68-75, April 2012

Effects of renin–angiotensin system blockades on cardiovascular outcomes in patients with diabetes mellitus: A systematic review and meta-analysis

Yoko M. Nakao
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- EBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
Satoshi Teramukai
- Department of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital, Kyoto, Japan
Sachiko Tanaka
- EBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
Shinji Yasuno
- EBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
Akira Fujimoto
- EBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
Masato Kasahara
- EBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
Kenji Ueshima
- EBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
Kazuhiro Nakao
- Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, Kyoto, Japan
Shiro Hinotsu
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
Kazuwa Nakao
- EBM Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, Kyoto, Japan
Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Corresponding author at: Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan. Tel.: +81 75 753 9469; fax: +81 75 753 4469.

Received 26 September 2011; received in revised form 16 November 2011; accepted 28 November 2011. published online 26 December 2011.

Abstract

Aim

To determine whether renin–angiotensin system (RAS) blockade is beneficial for cardiovascular outcomes in patients with diabetes mellitus (DM) using meta-analysis.

Methods

The MEDLINE and Cochrane library databases were searched for randomized controlled trials published up to June 2010. We also reviewed reference lists from identified trials and review articles to identify any other relevant studies, and the ClinicalTrials.gov website to identify randomized controlled trials that were registered as completed but not yet published. A random-effects model was used to combine the estimates for risk ratios (RR).

Results

Eligible studies were randomized controlled trials (including post hoc analyses) assessing the effects of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers on cardiovascular events compared to controls in patients with DM. Nineteen clinical trials with 41,042 patients and 6039 cardiovascular events were identified. RAS blockade significantly reduced the risk of major cardiovascular events (RR 0.92, 95% confidence interval [CI] 0.84–1.00, I² statistic 53%) and myocardial infarction (RR 0.82, 95% CI 0.72–0.94, I²=55%). There were trends towards fewer strokes and lower all-cause mortality but these were not statistically significant.

Conclusions

The available evidence shows that treatment with RAS blockade can routinely be considered for diabetic patients to reduce major cardiovascular events.

Keywords: Type 2 diabetes mellitus, Angiotensin-converting enzyme inhibitors, Angiotensin receptor blockers, Myocardial infarction, Meta-analysis