Reduced Mortality Associated With the Use of ACE Inhibitors in Patients With Type 2 Diabetes

Reduced Mortality Associated With the Use of ACE Inhibitors in Patients With Type 2 Diabetes Dean T. Eurich , BSP, MSC 1 2 , Sumit R. Majumdar , MD, MPH, FRCPC 1 3 , Ross T. Tsuyuki , PHARMD, MSC 1 4 and Jeffrey A. Johnson , PHD 1 2 1 Institute of Health Economics, Edmonton, Alberta, Canada 2 Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada 3 Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada 4 Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Address correspondence and reprint requests to Dr. Jeffrey A. Johnson, #1200, 10405 Jasper Ave., Edmonton, AB, Canada T5J 3N4. E-mail: jeff.johnson{at}ualberta.ca Abstract OBJECTIVE —ACE inhibitor therapy is widely used in lower-risk patients with type 2 diabetes to reduce mortality, despite limited evidence to support this clinical strategy. The aim of this study was to evaluate the association between ACE inhibitor use and mortality in patients with diabetes and no cardiovascular disease. RESEARCH DESIGN AND SETTINGS —Using the Saskatchewan health databases, 12,272 new users of oral hypoglycemic agents were identified between the years of 1991 and 1996. We excluded 3,202 subjects with previous cardiovascular disease. Of the remaining subjects, 1,187 “new users” of ACE inhibitors were identified (ACE inhibitor cohort). Subjects not receiving ACE inhibitor therapy throughout the follow-up period served as the control cohort ( n = 4,989). Subjects were prospectively followed until death or the end of 1999. Multivariate Cox proportional hazards models were used to assess differences in all-cause and cardiovascular-related mortality between cohort groups. RESULTS —Subjects were 60.7 ± 13.7 years old, 43.6% female, and were followed for an average of 5.3 ± 2.1 years. Mean duration of ACE inhibitor therapy was 3.6 ± 1.8 years. We observed significantly fewer deaths in the ACE inhibitor group (102 [8.6%]) compared with the control cohort (853 [17.1%]), with an adjusted hazard ratio (HR) and 95% CI of 0.49 (0.40–0.61) ( P < 0.001). Cardiovascular-related mortality was also reduced (40 [3.4%] vs. 261 [5.2%], adjusted HR, 0.63 [0.44–0.90]; P = 0.012). CONCLUSIONS —The use of ACE inhibitors was associated with a significant reduction in all-cause and cardiovascular-related mortality in a broad spectrum of patients with type 2 diabetes and no cardiovascular disease. CDS, Chronic Disea