title: Effects of renin-angiotensin system blockades on cardiovascular outcomes in patients with diabetes mellitus: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine whether renin-angiotensin system (RAS) blockade is beneficial for cardiovascular outcomes in patients with diabetes mellitus (DM) using meta-analysis.
  
  
  METHODS
  The MEDLINE and Cochrane library databases were searched for randomized controlled trials published up to June 2010. We also reviewed reference lists from identified trials and review articles to identify any other relevant studies, and the ClinicalTrials.gov website to identify randomized controlled trials that were registered as completed but not yet published. A random-effects model was used to combine the estimates for risk ratios (RR).
  
  
  RESULTS
  Eligible studies were randomized controlled trials (including post hoc analyses) assessing the effects of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers on cardiovascular events compared to controls in patients with DM. Nineteen clinical trials with 41,042 patients and 6039 cardiovascular events were identified. RAS blockade significantly reduced the risk of major cardiovascular events (RR 0.92, 95% confidence interval [CI] 0.84-1.00, I(2) statistic 53%) and myocardial infarction (RR 0.82, 95% CI 0.72-0.94, I(2)=55%). There were trends towards fewer strokes and lower all-cause mortality but these were not statistically significant.
  
  
  CONCLUSIONS
  The available evidence shows that treatment with RAS blockade can routinely be considered for diabetic patients to reduce major cardiovascular events.
authors.affiliation: Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
authors.forename: Yoko M
authors.initials: YM
authors.lastname: Nakao
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramukai
authors.forename: Sachiko
authors.initials: S
authors.lastname: Tanaka
authors.forename: Shinji
authors.initials: S
authors.lastname: Yasuno
authors.forename: Akira
authors.initials: A
authors.lastname: Fujimoto
authors.forename: Masato
authors.initials: M
authors.lastname: Kasahara
authors.forename: Kenji
authors.initials: K
authors.lastname: Ueshima
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nakao
authors.forename: Shiro
authors.initials: S
authors.lastname: Hinotsu
authors.forename: Kazuwa
authors.initials: K
authors.lastname: Nakao
authors.forename: Koji
authors.initials: K
authors.lastname: Kawakami
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors