title: Vascular and metabolic effects of combined therapy with ramipril and simvastatin in patients with type 2 diabetes.
abstract: Mechanisms underlying biological effects of statin and angiotensin-converting enzyme inhibitor therapies differ. Therefore, we compared vascular and metabolic responses to these therapies either alone or in combination in patients with type 2 diabetes. This was a randomized, double-blind, placebo-controlled crossover trial with 3 treatment arms (each 2 months) and 2 washout periods (each 2 months). Fifty patients with type 2 diabetes were given simvastatin 20 mg and placebo, simvastatin 20 mg and ramipril 10 mg, or ramipril 10 mg and placebo daily during each 2-month treatment period. Ramipril alone or combined therapy significantly reduced blood pressure when compared with simvastatin alone. When compared with ramipril alone, simvastatin alone or combined therapy significantly improved the lipoprotein profile. All 3 treatment arms significantly improved flow-mediated dilator response to hyperemia and reduced plasma levels of malondialdehyde relative to baseline measurements. However, these parameters were changed to a greater extent with combined therapy when compared with simvastatin or ramipril alone (P<0.001 by ANOVA). When compared with simvastatin or ramipril alone, combined therapy significantly reduced high-sensitivity C-reactive protein levels (P=0.004 by ANOVA). Interestingly, combined therapy or ramipril alone significantly increased plasma adiponectin levels and insulin sensitivity relative to baseline measurements. These changes were significantly greater than in the group treated with simvastatin alone (P<0.015 by ANOVA). Ramipril combined with simvastatin had beneficial vascular and metabolic effects when compared with monotherapy in patients with type 2 diabetes.
authors.affiliation: Department of Cardiology, Gachon Medical School, Incheon, Korea. kwangk@ghil.com
authors.forename: Kwang Kon
authors.initials: KK
authors.lastname: Koh
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Quon
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Han
authors.forename: Jeong Yeal
authors.initials: JY
authors.lastname: Ahn
authors.forename: Dong Kyu
authors.initials: DK
authors.lastname: Jin
authors.forename: Hyung Sik
authors.initials: HS
authors.lastname: Kim
authors.forename: Dae Sung
authors.initials: DS
authors.lastname: Kim
authors.forename: Eak Kyun
authors.initials: EK
authors.lastname: Shin
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002097:C-Reactive Protein / Q000378:metabolism; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood; D008315:Malondialdehyde / Q000097:blood; D017257:Ramipril / Q000627:therapeutic use*; D019821:Simvastatin / Q000627:therapeutic use*; D014664:Vasodilation / Q000187:drug effects
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D008315:Malondialdehyde; D002097:C-Reactive Protein; D019821:Simvastatin; D017257:Ramipril