Angiotensin-converting enzyme inhibition with enalapril slows progressive intima-media thickening of the common carotid artery in patients with non-insulin-dependent diabetes mellitus.

Abstract

BACKGROUND AND PURPOSE:

Whether angiotensin-converting enzyme (ACE) inhibitors have any clinically significant antiatherogenic effects in humans remains unproven. We undertook a prospective randomized clinical trial of 98 patients with non-insulin-dependent diabetes mellitus (NIDDM) to examine the efficacy of ACE inhibition with enalapril for preventing intima-media (IM) thickening of the carotid wall as measured ultrasonographically.

METHODS:

Ninety-eight NIDDM patients were randomly assigned either to enalapril at 10 mg/d (n=48) or to a control group (n=50); the planned duration of the trial was 2 years. All patients were seen at baseline (study entry) and 2 subsequent formal annual evaluations, in addition to standard clinical management for NIDDM. IM thickening and vascular lumen diameters were determined for all patients on the basis of baseline and 2 subsequent annual evaluations with carotid ultrasonography. We performed an intent-to-treat analysis to assess changes in IM thickening over the course of the study.

RESULTS:

Annual IM thickening measurements of the right and left common carotid arteries were 0.01+/-0.02 and 0.01+/-0.02 mm/y in the enalapril-treated group and 0.02+/-0.03 and 0.02+/-0.02 mm/y in the control group, respectively (P<0.05). From regression analysis, annual IM thickening was found to be predicted by enalapril use, sex, and insulin use (F(3,94)=3.86, P=0.012). When we controlled for these other variables, enalapril use reduced annual IM thickening of right and left common carotid arteries by 0.01+/-0.004 mm/y relative to the control group over the course of this study.

CONCLUSIONS:

Long-term treatment with an ACE inhibitor (enalapril) slows progressive IM thickening of the common carotid artery in NIDDM patients.

• Authors: N Hosomi, K Mizushige, H Ohyama, T Takahashi, M Kitadai, Y Hatanaka, H Matsuo, M Kohno, J A Koziol
• Journal: Stroke (Stroke) Vol. 32 Issue 7 Pg. 1539-45 (Jul 2001) ISSN: 1524-4628 [Electronic] United States
• PMID: 11441198 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Angiotensin-Converting Enzyme Inhibitors
• Enalapril

Topics

• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Arteriosclerosis (complications, drug therapy, pathology)
• Carotid Artery Diseases (complications, drug therapy, pathology)
• Carotid Artery, Common (diagnostic imaging, drug effects, pathology)
• Diabetes Mellitus, Type 2 (complications)
• Disease Progression
• Enalapril (therapeutic use)
• Female
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Tunica Intima (diagnostic imaging, pathology)
• Tunica Media (diagnostic imaging, pathology)
• Ultrasonography