(Circulation. 2001;103:919.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Effects of Ramipril and Vitamin E on Atherosclerosis
The Study to Evaluate Carotid Ultrasound Changes in Patients Treated With Ramipril and Vitamin E (SECURE)
From the Departments of Medicine (E.M.L., S.Y., Q.Y., S.S., A.M.-C., J.B., K.K.T.) and Radiology (C.I.D.), McMaster University, Hamilton, Ontario, Canada; The University of Alberta Hospitals, Edmonton, Alberta, Canada (V.D., K.K.T.); the Canadian Cardiovascular Collaboration (E.M.L., S.Y., V.D., C.I.D., Q.Y., S.S., A.M.-C., J.B., K.K.T.); and the Bowman Gray School of Medicine, Department of Neurology, Winston-Salem, NC (W.A.R.).
Correspondence to Eva Lonn, MD, Hamilton Health Sciences Corporation, General Site, 237 Barton Street East, Hamilton, Ontario, Canada L8L 2X2. E-mail hope{at}ccc.mcmaster.ca
Background—Activation of the renin-angiotensin-aldosterone system and oxidative modification of LDL cholesterol play important roles in atherosclerosis. The Study to Evaluate Carotid Ultrasound changes in patients treated with Ramipril and vitamin E (SECURE), a substudy of the Heart Outcomes Prevention Evaluation (HOPE) trial, was a prospective, double-blind, 3x2 factorial design trial that evaluated the effects of long-term treatment with the angiotensin-converting enzyme inhibitor ramipril and vitamin E on atherosclerosis progression in high-risk patients.
Methods and Results—A
total of 732 patients 
55 years of age who had vascular disease or
diabetes and at least one other risk factor and who did not have heart
failure or a low left ventricular ejection fraction were randomly
assigned to receive ramipril 2.5 mg/d or 10 mg/d and vitamin E
(RRR-
-tocopheryl acetate) 400 IU/d or their matching
placebos. Average follow-up was 4.5 years. Atherosclerosis progression
was evaluated by B-mode carotid ultrasound. The progression slope of
the mean maximum carotid intimal medial thickness was 0.0217 mm/year in
the placebo group, 0.0180 mm/year in the ramipril 2.5 mg/d group, and
0.0137 mm/year in the ramipril 10 mg/d group
(P=0.033). There were no
differences in atherosclerosis progression rates between patients on
vitamin E and those on placebo.
Conclusions—Long-term treatment with ramipril had a beneficial effect on atherosclerosis progression. Vitamin E had a neutral effect on atherosclerosis progression.
Key Words: atherosclerosis • angiotensin • carotid arteries • ultrasonics
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