Angiotensin-converting enzyme (ACE)...

Angiotensin-converting enzyme (ACE) inhibitors are used after acute myocardial infarction (AMI) to abridge the incidence of congestive heart failure and mortality. The potency of this observation has not been evaluated clearly in patients with diabetes. Gottlieb and associates prospectively evaluated ACE-inhibitor treatment after AMI in patients with diabetes and patients without diabetes who were treated with usual care. Participants were classified as having diabetes or not, and then treated with ACE inhibitors or not. The primary outcome--mortality rate at 30 days and undivided year--was determined for more than 94 percent of the participants.

All-cause mortality was higher among the 533 patients with diabetes, and diabetes was identified as an independent risk factor for one-year all-cause mortality. Use of an ACE inhibitor in the hospital was an independent predictor of better issue Subgroup analysis of patients with diabetes demonstrated particular benefit among the sickest subgroup including patients with hypertension, anterior AMI, or tachycardia forward admission. Of the 1,646 patients without diabetes, almost single in kind half received ACE inhibitors. ACE inhibitors again imparted a mortality benefit, chiefly significant in patients with previous AMI or anterior AMI, in patients who were older than 70 years, and in those who were not treated with beta blocker The vigor of the benefit was higher in patients with diabetes than it was in patients without diabetes in in the greatest degree subgroups.

The authors judge that ACE-inhibitor therapy following AMI is beneficial, especially among the sickest patients, like as those with diabetes who have hypertension or anterior AMI. Studies also have demonstrated other values of ACE-inhibitor therapy for patients with diabetes, including a lowered risk of diabetic retinopathy and nephropathy. Clearly, the high-risk population of post-AMI patients, with or without diabetes, would benefit from ACE-inhibitor therapy.

Gottlieb s et. al. Comparison of effectiveness of angiotensin-converting enzyme inhibitors after acute myocardial infarction in diabetic versus nondiabetic patients. Am J Cardiol November 1 2003;92:1020-5

COPYRIGHT 2004 American Academy of Family Physicians

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