Tuy nhiên, trong nghiên cứu hạ huyết áp và suy tim nghiêm trọng tại thời điểm ngẫu nhiên không phải là tiêu chuẩn loại trừ. GISSI-3, bằng cách sử dụng lisinopril, cho thấy 44% và giảm 27% tỷ lệ tử vong trong 6 tuần trong loại 1 và loại 2 bệnh nhân tiểu đường tương ứng. | CHAPTER 4 CORONARY HEART DISEASE AND DIABETES 41 1 0 1 2 3 4 5 6 Fig. Effects of simvastatin 20-40 mg on fatal and non-fatal cardiovascular events in patients with diabetes and non-diabetics with known CHD Scandanavian Simvastatin Survival Study 4S . negative interaction between aspirin and intravenous enalapril an 11 increase in mortality in the enalapril group . However in this study hypotension and severe cardiac failure at the time of randomization were not exclusion criteria. GISSI-3 using lisinopril showed a 44 and 27 reduction in 6-week mortality in type 1 and type 2 diabetics respectively. The large Heart Outcomes Prevention Evaluation HOPE study randomized patients with CHD but clinically normal left ventricular LV function to ramipril 10 mg or placebo with or without vitamin E. The diabetic subgroup Micro-HOPE of 3 577 patients were followed for a mean of years and treatment with ramipril was associated with a 24 reduction in all-cause mortality a 22 reduction in the rate of MI and a 33 reduction in the rate of stroke Fig. . Vitamin E had no benefit. Does improving glycaemic control reduce cardiovascular risk The Diabetes Complications and Control Trial DCCT of conventional vs. intensive glycaemic control in type 1 diabetes was underpowered to answer this question as the cohort was relatively young and therefore the number of events was low. There was a trend towards a reduction in cardiovascular events in the intensively treated group. The UK Prospective Diabetes Study UKPDS trial 42 SECTION I MICRO- AND MACROVASCULAR COMPLICATIONS OF DIABETES Fig. Micro-HOPE Study Effects of Ramipril or placebo on cardiovascular death in 3 577 diabetics with normal left ventricular function. Lancet 2000 355 253-259. also had a non-significant 16 reduction in fatal and non-fatal MIs in the intensively treated group after 15 years. Again this may be because of the relatively low event rate in a group of patients who were .
