Abstract 3925: Tissue-Specific Angiotensin-Converting Enzyme (ACE) Inhibitors in Prevention of Cardiovascular Disease in Patients with Diabetes Mellitus and Preserved Left Ventricular Function: A Pooled Meta-Analysis
Objective: A systematic meta-analysis of randomized placebo-controlled trials to evaluate the role of tissue ACE inhibitors in prevention of cardiovascular disease among patients with diabetes mellitus and preserved left ventricular function.
Study Selection: Randomized placebo-controlled trials of at least 12 months’ duration, in patients with diabetes mellitus and preserved left ventricular function who had experienced a prior cardiovascular event or were at high cardiovascular risk.
Data Synthesis and Analysis: 10,328 patients (43,517 patient-years) from 4 selected trials were studied. Statistical significance was determined using the Chi-square test (two-sided alpha error <0.05). The number of patients needed to treat (NNT) was also calculated.
Results: Tissue ACE inhibitors significantly reduced the risk of cardiovascular mortality (p=0.022), myocardial infarction (p=0.002), and the need for invasive coronary revascularization (p=0.015) when compared to placebo. The risk of overall mortality tended to be lower among patients randomized to tissue ACE inhibitors (p=0.08), while the risk of stroke and hospitalization for heart failure were unaffected. Treating about 60 patients with tissue ACE inhibitors for about 4.2 years would prevent one myocardial infarction, while treating about 80 patients would prevent one cardiovascular death.
Conclusion: Pooled meta-analysis of randomized placebo-controlled trials suggests that tissue ACE inhibitors modestly reduce the risk of myocardial infarction and cardiovascular death, and tend to reduce overall mortality in diabetic patients with preserved left ventricular function and high cardiovascular risk.