The HOPE Study and MICRO-HOPE Substudy effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus

BackgroundACE 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 dis...