The HOPE (Heart Outcomes Prevention Evaluation) Study Shows That Ramipril Helps Diabetic Patients

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Diabetes is ranked as the fifth cause of deaths in the United States and even worldwide. Having diabetes increases the risk of developing cardiovascular diseases and diabetic complications. Studies demonstrated that drugs that block or inhibit the rennin-angiotensin system, such as ramipril, may have preventive effects on diabetes.

In the HOPE trial (HOPE stands for Heart Outcomes Prevention Evaluation), the ramipril arm has 22% lower incidence of cardiovascular disease and 34% lower incidence of diabetes. Thus, people at high risk for cardiovascular diseases can benefit from using ramipril. Similarly, in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) trial, use of ACE inhibitor reduced the incidence of diabetes by 17%.

The question is whether people at high risk for diabetes and low risk for heart disease also benefit from using ramipril. The Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication (DREAM) study was designed to answer this question. It aimed to evaluate the preventive effects of ramipril on patients with impaired fasting glucose (IFG) levels or impaired glucose tolerance (IGT), but at low risk for cardiovascular diseases. 5269 subjects participated in the study and were followed for a median of follow-up of 3 years. Participants were assigned to receive either ramipril or matching placebo, and rosiglitazone or matching placebo. Diabetes developed in 17% of the ramipril group and 19.5% of the placebo group.

The study indicated that that the use of up to 15 mg of ramipril daily for 3 years does not have significant effects on diabetes incidence in people with impaired fasting glucose levels or impaired glucose tolerance but low risk for cardiovascular diseases. The Ramipril-taking group had more people with normal fasting glucose levels and glucose tolerance than the placebo group. This suggests that a longer study may be needed to evaluate the effects of ramipril on diabetes incidence in people with low risk for heart diseases.


Effect of Ramipril on the Incidence of Diabetes N Engl J Med 2006;355:1551-62.

The DREAM Trial Investigators. Rationale, design and recruitment characteristics of a large, simple international trial of diabetes prevention: the DREAM trial. Diabetologia 2004;47:1519-27.

Yusuf S, Gerstein H, Hoogwerf B, etal. Ramipril and the development of diabetes. JAMA 2001;286:1882-5.