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KMID : 0311120160570010180
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Yonsei Medical Journal
2016 Volume.57 No. 1 p.180 ~ p.186
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Impact of Angiotensin Converting Enzyme Inhibitor versus Angiotensin Receptor Blocker on Incidence of New-Onset Diabetes Mellitus in Asians
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Park Ji-Young
Rha Seung-Woon
Choi Byoung-Geol
Choi Se-Yeon
Choi Jae-Woong
Ryu Sung-Kee
Lee Se-Jin
Kim Seung-Hwan
Noh Yung-Kyun
Akkala Raghavender Goud
Li Hu
Ali Jabar
Kim Ji-Bak
Lee Sun-Ki
Na Jin-Oh
Choi Cheol-Ung
Lim Hong-Euy
Kim Jin-Won
Kim Eung-Ju
Park Chang-Gyu
Seo Hong-Seog
Oh Dong-Joo
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Abstract
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Purpose : Angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) are associated with a decreased incidence of new-onset diabetes mellitus (NODM). The aim of this study was to compare the protective effect of ACEI versus ARBs on NODM in an Asian population.
Materials and Methods : We investigated a total of 2817 patients who did not have diabetes mellitus from January 2004 to September 2009. To adjust for potential confounders, a propensity score matched (PSM) analysis was performed using a logistic regression model. The primary end-point was the cumulative incidence of NODM, which was defined as having a fasting blood glucose ≥126 mg/dL or HbA1c ≥6.5%. Multivariable cox-regression analysis was performed to determine the impact of ACEI versus ARB on the incidence of NODM.
Results : Mean follow-up duration was 1839±1019 days in all groups before baseline adjustment and 1864±1034 days in the PSM group. After PSM (C-statistics=0.731), a total 1024 patients (ACEI group, n=512 and ARB group, n=512) were enrolled for analysis and baseline characteristics were well balanced. After PSM, the cumulative incidence of NODM at 3 years was lower in the ACEI group than the ARB group (2.1% vs. 5.0%, p=0.012). In multivariate analysis, ACEI vs. ARB was an independent predictor of the lower incidence for NODM (odd ratio 0.37, confidence interval 0.17-0.79, p=0.010).
Conclusion : In the present study, compared with ARB, chronic ACEI administration appeared to be associated with a lower incidence of NODM in a series of Asian cardiovascular patients.
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KEYWORD
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Angiotensin converting enzyme inhibitor, angiotensin receptor blocker, diabetes mellitus
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