The HOPE Study: practical implications for people with diabetes

Abstract

Cardiovascular disease is a cause of premature morbidity and mortality in people with diabetes. Methods to reduce the burden of cardiovascular disease in diabetes have included control of glycaemia, reduction of conventional cardiovascular risk factors, and aggressive cardiological treatment for existing cardiovascular disease. ACE inhibitors have been used for control of hypertension, diabetic nephropathy, and for patients with a low ejection fraction. The Heart Outcomes Prevention Evaluation (HOPE) study examined the effects of 10 mg ramipril or placebo in 9297 high risk patients aged 55 or over. Diabetes was a pre-defined subgroup, and 3577 patient with diabetes were recruited who had evidence of vascular disease or had diabetes and one other cardiovascular risk factor (cholesterol>5.2, hypertension, microalbuminuria, smoking). The primary combined endpoint of myocardial infarction, stroke and cardiovascular death was significantly reduced by 25%, with a one third reduction in stroke. This reduction was seen both in patients with and without previous cardiovascular disease, and the benefit was greater than could be attributed to any decrease in blood pressure. The development of overt nephropathy was also reduced. This suggests that treatment with ramipril has vasculoprotective and renoprotective properties in people with diabetes, and should be prescribed or diabetic patients with existing cardiovascular disease or who have a high risk of disease because of the presence of cardiovascular risk factors. Copyright © 2000 John Wiley & Sons, Ltd.