ACEIs/ARBs for the prevention of type 2 diabetes in patients with cardiovascular diseases: a systematic review and meta-analysis

Purpose: Several studies have demonstrated that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce the incidence of type 2 diabetes in patients with cardiovascular diseases. Therefore, a systematic review and meta-analysis was performed to assess the clinical efficacy of ACEIs and ARBs in preventing type 2 diabetes. Methods: Randomized controlled trials (RCTs) were retrieved from PubMed, Embase, the Cochrane Library and Clinical Trials go through August 2015. Two reviewers independently assessed search results, extracted data, and appraised risk of bias. Results: A total of 21 studies met the inclusion criteria with a total of 111,768 subjects. Thereinto, 55962 patients randomly received ACEIs or ARBs, and 55824 received anti-hypertensive agents or a placebo. ACEIs and ARBs were associated with reductions in the incidence of newly diagnosed type 2 diabetes (ACEIs RR 0.76, 95% CI 0.67-0.87, P < 0.001; ARBs RR 0.79, 95% CI 0.74-0.85, P < 0.001; pooled analysis RR 0.78, 95% CI 0.73-0.84, P < 0.001). Conclusions: ACEIs or ARBs can reduce the incidence of type 2 diabetes, especially in patients with hypertension, metabolic syndrome, pre-diabetes phase, congestive heart failure, or coronary heart disease. ACEIs or ARBs is accordingly recommended as the first line antihypertensive agents in patients with cardiovascular diseases.