ACE Inhibitors and Statins in Adolescents With Type 1 Diabetes

Correspondence
A complete list of authors is available with the full text of this inactivated oral cholera vaccine in Bangladesh. N Engl J Med 2016;
letter at NEJM.org. 374:1723-32.
Supported by Médecins sans Frontières, by a grant to Drs. 3. Azman AS, Parker LA, Rumunu J, et al. Effectiveness of one
Azman and Luquero from the DOVE project at Johns Hopkins dose of oral cholera vaccine in response to an outbreak: a case-
Bloomberg School of Public Health, and by Institut Pasteur. cohort study. Lancet Glob Health 2016;4(11):e856-e863.
Disclosure forms provided by the authors are available with 4. Azman AS, Luquero FJ, Ciglenecki I, Grais RF, Sack DA,
the full text of this letter at NEJM.org. Lessler J. The impact of a one-dose versus two-dose oral cholera
vaccine regimen in outbreak settings: a modeling study. PLoS
1. Martin S, Lopez AL, Bellos A, et al. Post-licensure deploy- Med 2015;12(8):e1001867.
ment of oral cholera vaccines: a systematic review. Bull World 5. Luquero FJ, Grout L, Ciglenecki I, et al. Use of Vibrio cholerae
Health Organ 2014;92:881-93. vaccine in an outbreak in Guinea. N Engl J Med 2014;370:2111-20.
2. Qadri F, Wierzba TF, Ali M, et al. Efficacy of a single-dose, DOI: 10.1056/NEJMc1711583
ACE Inhibitors and Statins in Adolescents with Type 1 Diabetes

To the Editor: In reporting on the efficacy out- To the Editor: Marcovecchio and colleagues re-
comes in the Adolescent Type 1 Diabetes Cardio- port that ACE inhibitors and statins did not offer
Renal Intervention Trial (AdDIT), Marcovecchio benefits in reducing the albumin-to-creatinine
et al. (Nov. 2 issue)1 indicate that 222 patients ratio over a period of 2 to 4 years. However, with
received an angiotensin-converting–enzyme (ACE) respect to secondary outcomes such as carotid
inhibitor, 222 received a statin, and 220 received intima–media thickness and progression of reti-
placebo (Fig. 1 of the article, available at NEJM nopathy, the relatively short follow-up period may
.org). However, in the safety analysis, the num- make it difficult to observe differences between
ber of patients presented in Table 2 is different. intervention and control groups. Nielsen and
Moreover, Table 1 shows an ACE-inhibitor group, Nordestgaard observed that the cumulative inci-
a statin group, and two placebo groups. We hope dence of diabetic retinopathy was significantly
the authors will clarify the number of patients lower among statin users than among non-statin
considered in the efficacy and safety evaluation, users after a 13-year follow-up.1 A trial by Mauer
since 443 patients underwent randomization. et al.2 showed that the odds of progression of
In addition, the authors presented the data diabetic retinopathy were lower by 65% with the
for individual drug effects on the albumin-to- ACE inhibitor enalapril than with placebo dur-
creatinine ratio over time (Fig. 1 of the article). ing a 5-year follow-up. Given these other re-
However, the authors did not present cumula- sults, prolongation of the follow-up period would
tive data on the effect of the use of an ACE in- better demonstrate the effects of the drugs stud-
hibitor plus a statin on the albumin-to-creatinine ied here.
ratio. Zu‑Bing Mei, M.D., Ph.D.
Venu Gopal Jonnalagadda, M.S.Pharm., Shuguang Hospital affiliated to Shanghai University
of Traditional Chinese Medicine
P.G.D.R.A. Shanghai, China
Vijay Kranti Matety, M.S.Pharm. herrmayor@126.com
National Institute of Pharmaceutical Education and Research Yang Xiao, M.D., Ph.D.
Guwahati, India Second Xiangya Hospital of Central South University
gopalvenu63@gmail.com Changsha, China
Kanchan Choudhary, M.Pharm. Drs. Mei and Xiao report receiving grants (81774112,
81673768, and 81670772) from the National Natural Science
Bhupal Nobles’ Institute of Pharmaceutical Sciences Foundation of China. No other potential conflict of interest rel-
Udaipur, India evant to this letter was reported.
No potential conflict of interest relevant to this letter was re-
ported. 1. Nielsen SF, Nordestgaard BG. Statin use before diabetes di-
agnosis and risk of microvascular disease: a nationwide nested
matched study. Lancet Diabetes Endocrinol 2014;2:894-900.
1. Marcovecchio ML, Chiesa ST, Bond S, et al. ACE inhibitors 2. Mauer M, Zinman B, Gardiner R, et al. Renal and retinal
and statins in adolescents with type 1 diabetes. N Engl J Med effects of enalapril and losartan in type 1 diabetes. N Engl J Med
2017;377:1733-45. 2009;361:40-51.
DOI: 10.1056/NEJMc1715763 DOI: 10.1056/NEJMc1715763
n engl j med 378;6 nejm.org February 8, 2018 579

ACE Inhibitors and Statins in Adolescents With Type 1 Diabetes

Uploaded by

Copyright:

Available Formats

ACE Inhibitors and Statins in Adolescents With Type 1 Diabetes

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

ACE Inhibitors and Statins in Adolescents With Type 1 Diabetes

Uploaded by

Copyright:

Available Formats

Correspondence

ACE Inhibitors and Statins in Adolescents with Type 1 Diabetes

DOI: 10.1056/NEJMc1715763 DOI: 10.1056/NEJMc1715763

n engl j med 378;6 nejm.org February 8, 2018 579

You might also like