Effects of ramipril and rosiglitazone on cardiovascular and renal outcomes in people with impaired glucose tolerance or impaired fasting glucose - Results of the Diabetes Reduction Assessment with ramipril and rosiglitazone Medication (DREAM) trial
Effects of ramipril and rosiglitazone on cardiovascular and renal outcomes in people with impaired glucose tolerance or impaired fasting glucose - Results of the Diabetes Reduction Assessment with ramipril and rosiglitazone Medication (DREAM) trial
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DOI：
10.2337/dc07-1868
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发表时间：
2008-05-01
期刊：
影响因子：
16.2
通讯作者：
Yusuf, S.
中科院分区：
文献类型：
--
作者：
Dagenais, G. R.;Gerstein, H. C.;Yusuf, S.
目的-糖耐量受损（IGT）和/或空腹血糖受损（IFG）是糖尿病、心血管疾病（CVD）和肾脏疾病的危险因素。我们确定了雷米普利和rosightazone对糖尿病减少评估与雷米普利和rosightazone药物治疗（DREAM）试验中IGT和/或IFG患者的合并和个体CVD和肾脏结果的影响。研究设计和方法-共有5，269人年龄>= 30岁，患有IGT和/或IFG，没有已知的CVD或肾功能不全，随机分为15 mg/天雷米普利组和安慰剂组，以及8 mg/天rosightazone组和安慰剂组。在3年的随访中，评估了复合心肾结局及其CVD和肾脏成分。（15.7% [412/2，623] vs. 16.0% [424/2，646]风险比[HR] 0.98 [95% CI 0.84-1.13]; P = 0.75）或罗格列酮（15.0% [394/2，635] vs. 16.8% [442/2，634]; 0.87 [0.75-1.01]，P = 0.07）降低心肾复合结局的风险。拉米替尼对CVD和肾脏组分无影响。罗格列酮增加心力衰竭（0.53 vs. 0.08%; HR 7.04 [95% CI 1.60-31.0]; P = 0.01），但降低了肾脏成分的风险（0.80 [0.68-0.93]; P = 0.005）;糖尿病的预防与肾损害的预防独立相关（P < 0.001）。结论-雷米普利并不改变心肾损害的结果或其组成部分。罗格列酮，减少糖尿病，也减少肾脏疾病的发展，但不是心肾结果，并增加心力衰竭的风险。
OBJECTIVE - Impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) are risk factors for diabetes, cardiovascular disease (CVD), and kidney disease. We determined the effects of ramipril and rosightazone on combined and individual CVD and renal outcomes in people with IGT and/or IFG in the Diabetes REduction Assessment With ramipril and rosightazone Medication (DREAM) trial.RESEARCH DESIGN AND METHODS - A total of 5,269 people aged >= 30 years, with IGT and/or IFG without known CVD or renal insufficiency, were randomized to 15 mg/day ramipril versus placebo and 8 mg/day rosightazone versus placebo. A composite cardiorenal outcome and its CVD and renal components were assessed during the 3-year follow-up.RESULTS - Compared with placebo, neither raimpril (15.7% [412 of 2,623] vs. 16.0% [424 of 2,646] hazard ratio [HR] 0.98 [95% Cl 0.84-1.13]; P = 0.75) nor rosiglitazone (15.0% [394 of 2,635] vs. 16.8% [442 of 2,634]; 0.87 [0.75-1.01], P = 0.07) reduced the risk of the cardiorenal composite outcome. Ramipril had no impact on the CVD and renal components. Rosigltazone increased heart failure (0.53 vs. 0.08%; HR 7.04 [95% Cl 1.60-31.0]; P = 0.01) but reduced the risk of the renal component (0.80 [0.68-0.93]; P = 0.005); prevention of diabetes was independently associated with prevention of the renal component (P < 0.001).CONCLUSIONS - Ramipril did not alter the carchorenal outcome or its components. Rosiglitazone, which reduced diabetes, also reduced the development of renal disease but not the cardiorenal outcome and increased the risk of heart failure.