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

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• 作者：Yoko M. Nakao^a ; ^b ; Satoshi Teramukai^c ; Sachiko Tanaka^b ; Shinji Yasuno^b ; Akira Fujimoto^b ; Masato Kasahara^b ; Kenji Ueshima^b ; Kazuhiro Nakao^d ; Shiro Hinotsu^a ; Kazuwa Nakao^b ; ^d ; Koji Kawakami^a ; ^{kawakami.koji.4e@kyoto-u.ac.jp}
• 关键词：Type 2 diabetes mellitus ; Angiotensin-converting enzyme inhibitors ; Angiotensin receptor blockers ; Myocardial infarction ; Meta-analysis
• 刊名：Diabetes Research and Clinical Practice
• 出版年：2012
• 期刊代码：78_01688227
• 类别：med
• 出版时间：April, 2012
• 卷：96
• 期：1
• 页码：68-75
• 文件大小：595 K

摘要

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.