Blockade Of The Renin-angiotensin System Reduces The Incidence Of Type2Diabetes In Patients At High Risk Of Cardiovascular Disease:a Meta Analysis

Objectives:To assess the effects of inhibitors of the renin-angiotensin system(RAS), including angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in preventing the new onset of type2diabetes mellitus.Background:Type2diabetes mellitus is a world-wide epidemic disease and its prevalence is on the rise, which has become a major public health problem. So the prevention of diabetes is of great importance. Several studies have shown that ACEIs and ARBs decrease the incidence of new-onset type2diabetes in patients with hypertension or other cardiovascular risk factors. Therefore we performed a systematic review and meta-analysis to study the impact of ACEIs and ARBs on the incidence of new-onset type2diabetes mellitus.Methods:We searched databases including MEDLINE, EMBASE, OVID and CBM for all randomized controlled trails (RCTs) which reported new incident diabetes mellitus with ACEI or ARB therapies. We also searched references of all included studies and the database of ongoing studies. A total of21RCT are included in this meta-analysis. A random-effect model was used and heterogeneity was estimated. We also conducted sub-group analysis and sensitivity analysis.Results:Of the21studies that met the criteria,10used ACEIs and11used ARBs. There were55962patients randomized to ACEIs or ARBs and55824patients randomized to other therapies (anti-hypertensive agents or a placebo). ACEIs and ARBs were associated with reductions in the incidence of newly diagnosed type2diabetes (ACEIs RR0.78,95%CI0.70-0.88,P<0.001; ARBs RR0.82,95%CI0.75-0.88,P<0.001; pooled analysis RR0.8095%CI0.75-0.86,P<0.001). Conclusions:From our systematic review, the use of ACEIs or ARBs can reduce the incidence of new-onset type2diabetes mellitus, especially in patients with hypertension, metabolic syndrome, pre-diabetes phase (IFG/IGT), obesity, congestive heart failure, or coronary heart disease.This finding may be of special clinical benefit, so the use of an ACEI or ARB should be considered as the first line anti-hypertensive drug in these patients.