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
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Article info
Publication history
Published online: December 26, 2011
Accepted:
November 28,
2011
Received in revised form:
November 16,
2011
Received:
September 26,
2011
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
