Can Telmisartan Lower CVD Risk?

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Telmisartan shows an equivalent effect of vitamin C in further improving endothelial dysfunction after glycemia normalization in type 1 diabetes, by A. Ceriello and colleagues. Diabetes Care 30:1694-1698, 2007

What is the problem and what is known about it?

Studies have shown that having high blood glucose levels stops the endothelium (the lining covering the surface of blood vessels and parts of the heart) from working well. This can lead to cardiovascular disease (disease of the heart and blood vessels, also known as CVD). This means that people with diabetes, who often have high blood glucose levels, have an increased risk of CVD.

Why did the researchers do this particular study?

Scientists have shown that when the endothelium doesn’t work well in patients with type 1 diabetes, controlling blood glucose levels while taking an antioxidant (such as vitamin C) will make the endothelium work better. A drug called telmisartan is also known to help the heart and blood vessels recover from damage and stress. In this study, scientists wanted to study whether telmisartan also helps the endothelium work well.

Who was studied?

Thirty-six people with type 1 diabetes and 12 people without diabetes were included in the study. The 12 people without diabetes did not receive any treatment.

How was the study done?

The 36 diabetic patients were split into three groups. For the first 24 hours, all three groups received vitamin C as well as enough insulin and glucose to control blood glucose levels. Group 1 received only insulin and glucose for the first 12 hours, and then vitamin C was added for the last 12 hours. Group 2 only received vitamin C for the first 12 hours, and then insulin and glucose were added for the last 12 hours. Group 3 received vitamin C and insulin and glucose throughout the entire 24-hour period. After the first 24 hours had passed, one-half of each group received telmisartan for 1 month, and the other half of each group did not receive any telmisartan.

What did the researchers find?

After the first 24 hours, groups 1 and 3 (who received insulin and glucose for the entire 24-hour period) had better blood glucose control than group 2. The endothelium worked better in the groups who received vitamin C during the full 24-hour period (groups 2 and 3). It seems that controlling blood glucose and taking vitamin C at the same time has the best effect on the endothelium. Telmisartan also made the endothelium work better in the subjects who took it.

What are the limitations of the study?

If the study had been done on more patients, the researchers might be able to be more certain of the findings.

What are the implications of the study?

This study shows that in patients with type 1 diabetes, improving blood glucose levels and taking an antioxidant, such as vitamin C, at the same time can help the endothelium work better. Recent studies have found that vitamin C can be dangerous in older women with type 2 diabetes, so it is good news that telmisartan can work like vitamin C when combined with good blood glucose control.

FOR MORE INFORMATION

Nutritional disease prevention

Antioxidants

Telmisartan (also known as an angiotensin II receptor blocker)

Heart and Blood Vessel Disease