ACE Inhibitor, Statin No Benefit for T1DM, High Albumin Excretion
THURSDAY, Nov. 2, 2017 -- For adolescents with type 1 diabetes and high levels of albumin excretion, neither angiotensin-converting-enzyme (ACE) inhibitors nor statins change the albumin-to-creatinine ratio over time, according to a study published online Nov. 1 in the New England Journal of Medicine.
M. Loredana Marcovecchio, M.D., from the University of Cambridge in the United Kingdom, and colleagues randomized 443 adolescents (aged 10 to 16 years) with type 1 diabetes and an albumin-to-creatinine ratio in the upper third in a placebo-controlled trial of an ACE inhibitor and a statin using a 2-by-2 factorial design. The primary outcome was the change in albumin excretion, measured according to the albumin-to-creatinine ratio.
The researchers that neither ACE inhibitor therapy nor statin therapy affected the primary outcome; the same was true for combination therapy. Lower incidence of microalbuminuria was seen with use of an ACE inhibitor versus placebo; this was not considered significant in the context of negative findings for the primary outcome and statistical analysis plan (hazard ratio, 0.57; 95 percent confidence interval, 0.35 to 0.94). Significant reductions were seen in total, low-density lipoprotein, and non-high-density lipoprotein cholesterol levels; in triglyceride levels; and in the ratio of apolipoprotein B to apolipoprotein A1 with statin use; neither drug had significant effects on carotid intima-media thickness, other cardiovascular markers, glomerular filtration rate, or progression of retinopathy.
"The use of an ACE inhibitor and a statin did not change the albumin-to-creatinine ratio over time," the authors write.
Several authors disclosed ties to the biopharmaceutical industry.
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Posted: November 2017