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Although angiotensin-converting enzyme inhibitors have not been shown to have a direct effect on anginal symptoms, they have been shown to be beneficial in diabetic patients with at least one cardiovascular risk factor but no prior history of cardiovascular disease. The Microalbuminuria, Cardiovascular, and Renal Outcomes (MICRO) HOPE diabetic sub-study of the Heart Outcomes Prevention Evaluation (HOPE) study demonstrated that ramipiril therapy was associated with a 25% relative risk reduction in the combined endpoint of myocardial infarction (MI), stroke, or cardiovascular death and a 20% relative risk reduction in heart failure.1

Angiotensin converting enzyme inhibitors have a well-established role in the early therapy of diabetic patients who have suffered an MI. In the diabetic subgroup of the Gruppo Italiano per lo Studio della Sopravvivenza nellInfarcto Miocardio (GISSI-3) trial, treatment with lisinopril was associated with a 30% reduction in 6-week mortality. Most, but not all, of survival gains in diabetic patients was maintained at 6-month follow-up despite the withdrawal of the ACE inhibitors treatment at 6-weeks.3

[1] HOPE Investigators. Effects of Ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results from the HOPE study and MICRO-HOPE sub-study. Lancet. 2000; 355(9200):253-259

[2] Eurich, et al. Reduced mortality associated with the use of ACE Inhibitors in patients with type 2 diabetes. Diabetes Care. 2004; 27(6):1330-1334

[3] Zuanetti, et al. Effect of the ACE Inhibitor Lisinopril on mortality in diabetic patients with acute myocardial infarction (data from the GISSI-3 study). Circulation. 1997; 96:4239-4245