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Ramipril and Risk of Diabetes—Reply

Salim Yusuf, DPhil, FRCPC
JAMA. 2002;287(2):186-187. doi:10.1001/jama.287.2.186.
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In Reply: Dr Potyk raises the interesting question of what is gained by secondary publications from large trials after the main article has been published. First, the main report of a trial is generally too concise to include all the important information. Second, some information (usually secondary outcomes) may be mentioned very briefly (eg, 1 line regarding prevention of diabetes with ramipril in our original article) so that the information is either missed by readers or is not provided in adequate detail for careful evaluation.1 Third, some data are of interest to some parts of the scientific community and not to others. As an example, in HOPE there was substantial benefit with ramipril among those with peripheral arterial disease. Hence a detailed and separate report would be necessary. Fourth, substudies that focus on specific outcomes not included in the primary report (eg, carotid atherosclerosis,2 left ventricular hypertrophy, renal disease progression) require separate publication. Fifth, new observational analysis (eg, the prediction of events by even small increases in urinary microalbumin excretion) deserve public dissemination.3 We believe that an enormous amount of useful knowledge can be derived from large carefully conducted studies through judicious publications and that full dissemination of these results is likely to be helpful to the scientific community.


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