Effect of ramipril on the incidence of diabetes

The Dream Trial Investigators

Research output: Contribution to journalArticle

587 Citations (Scopus)

Abstract

Background: Previous studies have suggested that blockade of the renin-angiotensin system may prevent diabetes in people with cardiovascular disease or hypertension. Methods: In a double-blind, randomized clinical trial with a 2-by-2 factorial design, we randomly assigned 5269 participants without cardiovascular disease but with impaired fasting glucose levels (after an 8-hour fast) or impaired glucose tolerance to receive ramipril (up to 15 mg per day) or placebo (and rosiglitazone or placebo) and followed them for a median of 3 years. We studied the effects of ramipril on the development of diabetes or death, whichever came first (the primary outcome), and on secondary outcomes, including regression to normoglycemia. Results: The incidence of the primary outcome did not differ significantly between the ramipril group (18.1%) and the placebo group (19.5%; hazard ratio for the ramipril group, 0.91; 95% confidence interval [CI], 0.81 to 1.03; P = 0.15). Participants receiving ramipril were more likely to have regression to normoglycemia than those receiving placebo (hazard ratio, 1.16; 95% CI, 1.07 to 1.27; P = 0.001). At the end of the study, the median fasting plasma glucose level was not significantly lower in the ramipril group (102.7 mg per deciliter [5.70 mmol per liter]) than in the placebo group (103.4 mg per deciliter [5.74 mmol per liter], P = 0.07), though plasma glucose levels 2 hours after an oral glucose load were significantly lower in the ramipril group (135.1 mg per deciliter [7.50 mmol per liter] vs. 140.5 mg per deciliter [7.80 mmol per liter], P = 0.01). Conclusions: Among persons with impaired fasting glucose levels or impaired glucose tolerance, the use of ramipril for 3 years does not significantly reduce the incidence of diabetes or death but does significantly increase regression to normoglycemia.

Original languageEnglish
Pages (from-to)1551-1562
Number of pages12
JournalNew England Journal of Medicine
Volume355
Issue number15
DOIs
Publication statusPublished - 12-10-2006
Externally publishedYes

Fingerprint

Ramipril
Incidence
Placebos
Glucose
Fasting
Glucose Intolerance
rosiglitazone
Cardiovascular Diseases
Confidence Intervals
Renin-Angiotensin System
Randomized Controlled Trials
Hypertension

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

The Dream Trial Investigators. / Effect of ramipril on the incidence of diabetes. In: New England Journal of Medicine. 2006 ; Vol. 355, No. 15. pp. 1551-1562.
@article{4de876e2d49d48fc9ec5cb376528b9c7,
title = "Effect of ramipril on the incidence of diabetes",
abstract = "Background: Previous studies have suggested that blockade of the renin-angiotensin system may prevent diabetes in people with cardiovascular disease or hypertension. Methods: In a double-blind, randomized clinical trial with a 2-by-2 factorial design, we randomly assigned 5269 participants without cardiovascular disease but with impaired fasting glucose levels (after an 8-hour fast) or impaired glucose tolerance to receive ramipril (up to 15 mg per day) or placebo (and rosiglitazone or placebo) and followed them for a median of 3 years. We studied the effects of ramipril on the development of diabetes or death, whichever came first (the primary outcome), and on secondary outcomes, including regression to normoglycemia. Results: The incidence of the primary outcome did not differ significantly between the ramipril group (18.1{\%}) and the placebo group (19.5{\%}; hazard ratio for the ramipril group, 0.91; 95{\%} confidence interval [CI], 0.81 to 1.03; P = 0.15). Participants receiving ramipril were more likely to have regression to normoglycemia than those receiving placebo (hazard ratio, 1.16; 95{\%} CI, 1.07 to 1.27; P = 0.001). At the end of the study, the median fasting plasma glucose level was not significantly lower in the ramipril group (102.7 mg per deciliter [5.70 mmol per liter]) than in the placebo group (103.4 mg per deciliter [5.74 mmol per liter], P = 0.07), though plasma glucose levels 2 hours after an oral glucose load were significantly lower in the ramipril group (135.1 mg per deciliter [7.50 mmol per liter] vs. 140.5 mg per deciliter [7.80 mmol per liter], P = 0.01). Conclusions: Among persons with impaired fasting glucose levels or impaired glucose tolerance, the use of ramipril for 3 years does not significantly reduce the incidence of diabetes or death but does significantly increase regression to normoglycemia.",
author = "{The Dream Trial Investigators} and Jackie Bosch and Salim Yusuf and Gerstein, {Hertzel C.} and Janice Pogue and Patrick Sheridan and Gilles Dagenais and Chiasson, {Jean Louis} and Rafael Diaz and Alvaro Avezum and Fernando Lanas and Jeffrey Probstfield and George Fodor and Holman, {Rury R.} and Gerstein, {H. C.} and S. Yusuf and Holman, {R. R.} and S. Anand and A. Avezum and A. Budaj and Chiasson, {J. L.} and I. Conget and G. Dagenais and M. Davis and R. Diaz and N. Dinccag and M. Enjalbert and A. Escalante and G. Fodor and M. Hanefeld and T. Hedner and K. Jolly and M. Keltai and M. Laakso and F. Lanas and E. Lonn and M. McQueen and V. Mohan and A. Phillips and L. Piegas and V. Pirags and J. Probstfield and I. Schmid and J. Shaw and K. Teo and P. Zimmet and B. Zinman and R. Diaz and {Ahuad Guerrero}, R. and C. Rao and V. Kumar",
year = "2006",
month = "10",
day = "12",
doi = "10.1056/NEJMoa065061",
language = "English",
volume = "355",
pages = "1551--1562",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "15",

}

Effect of ramipril on the incidence of diabetes. / The Dream Trial Investigators.

In: New England Journal of Medicine, Vol. 355, No. 15, 12.10.2006, p. 1551-1562.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of ramipril on the incidence of diabetes

AU - The Dream Trial Investigators

AU - Bosch, Jackie

AU - Yusuf, Salim

AU - Gerstein, Hertzel C.

AU - Pogue, Janice

AU - Sheridan, Patrick

AU - Dagenais, Gilles

AU - Chiasson, Jean Louis

AU - Diaz, Rafael

AU - Avezum, Alvaro

AU - Lanas, Fernando

AU - Probstfield, Jeffrey

AU - Fodor, George

AU - Holman, Rury R.

AU - Gerstein, H. C.

AU - Yusuf, S.

AU - Holman, R. R.

AU - Anand, S.

AU - Avezum, A.

AU - Budaj, A.

AU - Chiasson, J. L.

AU - Conget, I.

AU - Dagenais, G.

AU - Davis, M.

AU - Diaz, R.

AU - Dinccag, N.

AU - Enjalbert, M.

AU - Escalante, A.

AU - Fodor, G.

AU - Hanefeld, M.

AU - Hedner, T.

AU - Jolly, K.

AU - Keltai, M.

AU - Laakso, M.

AU - Lanas, F.

AU - Lonn, E.

AU - McQueen, M.

AU - Mohan, V.

AU - Phillips, A.

AU - Piegas, L.

AU - Pirags, V.

AU - Probstfield, J.

AU - Schmid, I.

AU - Shaw, J.

AU - Teo, K.

AU - Zimmet, P.

AU - Zinman, B.

AU - Diaz, R.

AU - Ahuad Guerrero, R.

AU - Rao, C.

AU - Kumar, V.

PY - 2006/10/12

Y1 - 2006/10/12

N2 - Background: Previous studies have suggested that blockade of the renin-angiotensin system may prevent diabetes in people with cardiovascular disease or hypertension. Methods: In a double-blind, randomized clinical trial with a 2-by-2 factorial design, we randomly assigned 5269 participants without cardiovascular disease but with impaired fasting glucose levels (after an 8-hour fast) or impaired glucose tolerance to receive ramipril (up to 15 mg per day) or placebo (and rosiglitazone or placebo) and followed them for a median of 3 years. We studied the effects of ramipril on the development of diabetes or death, whichever came first (the primary outcome), and on secondary outcomes, including regression to normoglycemia. Results: The incidence of the primary outcome did not differ significantly between the ramipril group (18.1%) and the placebo group (19.5%; hazard ratio for the ramipril group, 0.91; 95% confidence interval [CI], 0.81 to 1.03; P = 0.15). Participants receiving ramipril were more likely to have regression to normoglycemia than those receiving placebo (hazard ratio, 1.16; 95% CI, 1.07 to 1.27; P = 0.001). At the end of the study, the median fasting plasma glucose level was not significantly lower in the ramipril group (102.7 mg per deciliter [5.70 mmol per liter]) than in the placebo group (103.4 mg per deciliter [5.74 mmol per liter], P = 0.07), though plasma glucose levels 2 hours after an oral glucose load were significantly lower in the ramipril group (135.1 mg per deciliter [7.50 mmol per liter] vs. 140.5 mg per deciliter [7.80 mmol per liter], P = 0.01). Conclusions: Among persons with impaired fasting glucose levels or impaired glucose tolerance, the use of ramipril for 3 years does not significantly reduce the incidence of diabetes or death but does significantly increase regression to normoglycemia.

AB - Background: Previous studies have suggested that blockade of the renin-angiotensin system may prevent diabetes in people with cardiovascular disease or hypertension. Methods: In a double-blind, randomized clinical trial with a 2-by-2 factorial design, we randomly assigned 5269 participants without cardiovascular disease but with impaired fasting glucose levels (after an 8-hour fast) or impaired glucose tolerance to receive ramipril (up to 15 mg per day) or placebo (and rosiglitazone or placebo) and followed them for a median of 3 years. We studied the effects of ramipril on the development of diabetes or death, whichever came first (the primary outcome), and on secondary outcomes, including regression to normoglycemia. Results: The incidence of the primary outcome did not differ significantly between the ramipril group (18.1%) and the placebo group (19.5%; hazard ratio for the ramipril group, 0.91; 95% confidence interval [CI], 0.81 to 1.03; P = 0.15). Participants receiving ramipril were more likely to have regression to normoglycemia than those receiving placebo (hazard ratio, 1.16; 95% CI, 1.07 to 1.27; P = 0.001). At the end of the study, the median fasting plasma glucose level was not significantly lower in the ramipril group (102.7 mg per deciliter [5.70 mmol per liter]) than in the placebo group (103.4 mg per deciliter [5.74 mmol per liter], P = 0.07), though plasma glucose levels 2 hours after an oral glucose load were significantly lower in the ramipril group (135.1 mg per deciliter [7.50 mmol per liter] vs. 140.5 mg per deciliter [7.80 mmol per liter], P = 0.01). Conclusions: Among persons with impaired fasting glucose levels or impaired glucose tolerance, the use of ramipril for 3 years does not significantly reduce the incidence of diabetes or death but does significantly increase regression to normoglycemia.

UR - http://www.scopus.com/inward/record.url?scp=33749590988&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33749590988&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa065061

DO - 10.1056/NEJMoa065061

M3 - Article

VL - 355

SP - 1551

EP - 1562

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 15

ER -