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January 9, 2002

Ramipril and Risk of DiabetesAre Weekly Courses of Antenatal Steroids Beneficial or Dangerous?Cost-effectiveness of Homocysteine-Lowering Therapy to Prevent Coronary Heart Disease

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2002;287(2):186-187. doi:10.1001/jama.287.2.186

To the Editor: Dr Yusuf and colleagues,1 for the Heart Outcomes Prevention Evaluation (HOPE) study investigators, reported that patients with known vascular disease had lower risk of developing diabetes if they were given ramipril rather than placebo. The initial publication of the HOPE study2 reported a 22% decrease in the composite end point of myocardial infarction, stroke, or death from cardiovascular causes among high-risk patients treated with ramipril compared with placebo. There were also statistically significant decreases in each component of the composite end point as well. Similarly, that previous article reported results of preplanned subgroup analysis that showed ramipril to be of particular benefit in patients with diabetes mellitus, microalbuminuria, hypertension, and cardiovascular disease. The authors observed that a new diagnosis of diabetes mellitus was made less frequently in the treatment group compared with the placebo group.2

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