Effects of Ramipril and Rosiglitazone onudCardiovascular and Renal Outcomes inudPeople With Impaired Glucose Toleranceudor Impaired Fasting Glucose

摘要

OBJECTIVE— Impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) areudrisk factors for diabetes, cardiovascular disease (CVD), and kidney disease. We determined theudeffects of ramipril and rosiglitazone on combined and individual CVD and renal outcomes inudpeople with IGT and/or IFG in the Diabetes REduction Assessment With ramipril and rosiglitazoneudMedication (DREAM) trial.udRESEARCH DESIGNANDMETHODS— A total of 5,269 people aged30 years, withudIGT and/or IFG without known CVD or renal insufficiency, were randomized to 15 mg/dayudramipril versus placebo and 8 mg/day rosiglitazone versus placebo. A composite cardiorenaludoutcome and its CVD and renal components were assessed during the 3-year follow-up.udRESULTS— Compared with placebo, neither ramipril (15.7% [412 of 2,623] vs. 16.0% [424udof 2,646]; hazard ratio [HR] 0.98 [95% CI 0.84 –1.13]; P0.75) nor rosiglitazone (15.0% [394udof 2,635] vs. 16.8% [442 of 2,634]; 0.87 [0.75–1.01]; P 0.07) reduced the risk of theudcardiorenal composite outcome. Ramipril had no impact on the CVD and renal components.udRosiglitazone increased heart failure (0.53 vs. 0.08%; HR 7.04 [95% CI 1.60 –31.0]; P 0.01)udbut reduced the risk of the renal component (0.80 [0.68–0.93]; P 0.005); prevention ofuddiabetes was independently associated with prevention of the renal component (P 0.001).udCONCLUSIONS— Ramipril did not alter the cardiorenal outcome or its components. Rosiglitazone,udwhich reduced diabetes, also reduced the development of renal disease but not theudcardiorenal outcome and increased the risk of heart failure.