New stroke guidelines will be among topics discussed at the 26th International Stroke Conference of the American Stroke Association (ASA), a division of the American Heart Association (AHA). These new guidelines recommend use of ramipril --Altace® -- in at risk people with diabetes to prevent stroke. These recommendations were published in Circulation and Stroke in January 2001 and are based on data from the HOPE (Heart Outcomes Prevention Evaluation) Study which demonstrated that people with diabetes can reduce their risk of stroke by 33 percent, even if they are already taking other medications.
According to a new International Communications Research survey
commissioned by the Chicago Center for Clinical Research more than two-thirds
of Americans are unaware that, like obesity and smoking, diabetes is a major
risk factor for cardiovascular disease. Experts from the Chicago Center for
Clinical Research say that by failing to make the link, many people with
diabetes are missing the benefits of available preventive therapies such as
Altace, for heart attack and stroke.
Nearly 40% of the survey respondents thought that the number one killer of
people with diabetes is kidney failure. Only 14 percent knew that the correct
answer is cardiovascular disease, the leading killer of all Americans. More
than 60 percent of people with diabetes die of some form of heart or blood
vessel disease compared to 40 percent of the general population. People with
diabetes are two to four times more likely to suffer from heart disease, yet
the survey found that few Americans know that this increased risk exists. In
addition, people with diabetes are also two to four times more likely to
suffer a stroke.
"It's frightening that so few people understand the very direct impact
diabetes has on their risk for suffering a heart attack or stroke," said
Michael Davidson, MD, Chief Executive Officer and President, Chicago Center
for Clinical Research and Director of Preventive Cardiology at Rush Medical
School. "These new guidelines make it clear that simply adding Altace to a
current treatment regimen can give added protection for reducing the risk of
stroke. However, more people need to become aware of the link between
diabetes and cardiovascular disease to ensure that they are doing as much as
they can to reduce this risk."
"Approximately 16 million Americans-about one in every 12 adults-suffers
from diabetes," said Dr. Jeffrey Probstfield, M.D., Professor of Medicine,
University of Washington and Investigator of the Heart Outcomes Prevention
Evaluation (HOPE) Study. "The incidence of diabetes greatly increases with
age. More than one in six Americans age 65 and over has diabetes. Because
the risk of cardiovascular disease also increases with age, the threat of
cardiovascular disease should be a particular concern for older adults with
The HOPE Trial
The HOPE trial included a subset of 3,500 patients who had diabetes plus
at least one other cardiovascular risk factor. The study compared the outcomes
of patients getting Altace(R) (ramipril) or a placebo. The study medication
was added to other therapies for cardiovascular disease, such as aspirin, beta
blockers or lipid lowering agents.
"In patients with diabetes who took Altace, the risk reduction for stroke
was 33%; for heart attack it was 22%; and for cardiovascular death it was 37%.
The HOPE results also showed that Altace protects people with diabetes beyond
just reducing risk of events. Patients treated with Altace have a 22%
reduction in the need for laser eye therapy and a 16% lower risk of permanent
kidney damage," says Dr. Probstfield. The results of the HOPE trial were
published earlier this year in The New England Journal of Medicine.
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