Oct. 16, 2001 -- A popular drug used to treat high blood pressure and heart disease, and recently shown to help prevent strokes and heart attacks, also appears to reduce the risk of developing diabetes. In a large trial first reported last year, researchers found that people at high risk for developing diabetes who take the drug Altace were 34% less likely to develop diabetes than those who did not get the drug.
Those findings have now been confirmed in a detailed analysis, published in the Oct. 17 issue of TheJournal of the American Medical Association. But experts say it is too soon to recommend Altace or any other drug of its type solely for the reduction of diabetes risk.
"This is an exciting finding, which could potentially open up new ways of preventing both diabetes and heart disease," researcher Salim Yusuf, FRCPC, of Ontario's McMaster University tells WebMD. He adds that the standard diabetes drugs "haven't been shown to reduce heart disease convincingly, but we know that this drug does."
Approximately 16 million people in the U.S. have diabetes, and more than 90% have a form called type 2 or adult-onset diabetes. Another 10 million Americans are considered to be at high risk for developing it, especially as the U.S. population ages.
People with diabetes are up to four-times more likely to have heart disease or suffer a stroke than the general population. In fact, some form of heart complication such as a heart attack is present in 75% of diabetes-related deaths, but American Diabetes Association spokesman Nathaniel G. Clark, MD, says doctors are only now beginning to understand the importance of preventing these cardiovascular complications in diabetic patients.
As far as treating people with diabetes, Clark tells WebMD: "In the past, we have focused on the need to control blood sugar, which is, of course, important. ... But the reality is that for patients with type 2 diabetes, the most significant complications in terms of the time spent in hospitals and death are ... problems like heart attack and stroke."
Clark says the findings from the Heart Outcomes Prevention Evaluation (HOPE) study are intriguing but not conclusive because the diabetes data were incidental findings. The study's primary focus was to determine if taking Altace, a type of drug called an ACE inhibitor, prevented heart attacks in people at high risk for having one. People at risk for diabetes have similar risk profiles of people at risk of heart disease.
As hoped, significant reductions in deaths from heart attack, strokes, or other cardiovascular diseases were seen among participants taking the ACE inhibitor. But the reduction in diabetes incidence was unexpected, Yusuf says. A total of 3.6% of the participants taking ramipril developed type 2 diabetes, compared to 5.4% of participants given a dummy pill for comparison.
Now, Yusuf says, his research team has begun a new study designed to directly evaluate whether Altace prevents diabetes in some 4,000 subjects at high risk for the disease.
Although the HOPE trial evaluated only Altace, Clark says other ACE inhibitors, like Vasotec or Lotensin, may have similar protective properties for people at high risk for cardiovascular disease and diabetes. And he points out that new research, published last month in The New England Journal of Medicine, suggests that a similar class of high blood pressure drugs known as angiotensin-receptor blocking agents, may be protective against diabetes-related kidney disease. Clark is the American Diabetes Association's national vice president for clinical affairs.
"There is clearly a lot of discussion about what should be the drug of choice for someone with diabetes and hypertension," Clark says. "There is a lot of information, and it suggests that one class of drugs may be better at preventing some diabetes complications and another may be better for others."
He says the evidence is mounting that making modest lifestyle changes may be the most important factor in lowering the risk of diabetes. A large clinical trial found that people at high risk who exercised moderately and lost just 5% to 7% of their body weight reduced their risk of type 2 diabetes by almost 60%. Those who did not change their lifestyles, but took a widely prescribed diabetes drug reduced their risk by only 31%.
"We are not talking about huge lifestyle changes," he says. "These people exercised 30 minutes a day, five days a week. And the average weight loss was 15 pounds over two years. But the results were remarkable. There is no question that diet and exercise are hugely important in reducing diabetes risk."