The HOPE Study and MICRO-HOPE Substudy

Abstract

Background

ACE inhibitors have a special role in diabetes care. They have been proven to reduce urinary albumin excretion and reduce the rate of progression of diabetic nephropathy and retinopathy.^1-3 There is proven benefit post myocardial infarction, with a greater beneficial effect in patients with diabetes in comparison to those without.⁴ The effect of ACE inhibitors in patients who have low ejection fractions or overt cardiac failure is well described.⁵ More recent studies indicate other benefits of ACE inhibitors such as improving dyslipidaemia and insulin sensitivity.

Cardiovascular disease is the commonest cause of mortality among patients with type 2 diabetes. A recent study reports the standardised mortality ratio to be considerably higher in people with diabetes with the vast majority of the excess due to cardiovascular disease (type 1 diabetes: women x 6.41, men x 2.94, type 2 diabetes: women x 1.6, men x 1.41).⁶ Patients with type 2 diabetes who have no evidence of previous coronary heart disease were found to be at the same risk of myocardial infarction and cardiovascular death as non-diabetic patients who had already suffered from a myocardial infarction.⁷

The diabetes subject cohort of the HOPE Study, (Heart Outcomes Prevention Evaluation Study), sought to investigate whether ACE inhibitor treatment with ramipril in high-risk patients with diabetes lowers the risk of cardiovascular events.⁸ Within this main study the MICRO-HOPE substudy investigated the effect of ACE inhibitor treatment with ramipril on microalbuminuria and diabetic retinopathy.⁹ The aim of this article is to offer a clinical summary of the above studies and suggest recommendations for clinical practice.

Keywords

diabetes cardiovascular disease microvascular complications HOPE study ACE inhibitor.

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