BMJ  2005;330:1269-1270 (28 May), doi:10.1136/bmj.330.7502.1269-a

Letter

Angiotensin receptor blockers and myocardial infarction

Results reflect different cardiovascular states in patients with types 1 and 2 diabetes

The first 150 words of the full text of this article appear below.

Editor—Verma and Strauss's editorial supports the contention that angiotensin receptor blockers are associated with increased risk of myocardial infarction.¹ Included in the documentation of this risk are briefing documents from the US Food and Drug Administration quoting data from the irbesartan diabetic nephropathy trial.² However, the authors did not cite our published analysis of cardiovascular events during this trial.³ Omitted was any mention that the difference between irbesartan and placebo or amlodipine did not reach significance with respect to myocardial infarctions (P > 0.2 and P = 0.068, respectively). Neither were death rates different.²

A meta-analysis cited in the editorial used faulty logic.⁴ Its conclusion emphasised that mortality in studies of diabetic nephropathy using angiotensin converting enzyme (ACE) inhibitors was lower than in studies using angiotensin receptor blockers, with the erroneous implication that ACE inhibitors are safer. Most patients in studies using these drugs had type 1 diabetes mellitus, whereas . . . [Full text of this article]

¹ Section of Nephrology, Rush University Medical Center, 1653 W Congress Parkway, Chicago, IL 60612, USA Helen_Follmer@rush.edu

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