doi: 10.1161/hc3001.093502
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2001;104:522.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Effects of Ramipril on Coronary Events in High-Risk Persons
Results of the Heart Outcomes Prevention Evaluation Study
From the Quebec Heart Institute, Laval University, Ste-Foy, Canada (G.R.D.); the Hamilton General Hospital, McMaster University, Hamilton, Canada (S.Y., Q.Y., J.B., E.M.L.); the Montreal Heart Institute, University of Montreal, Montreal, Canada (M.G.B.); the Centre Hospitalier de Lanaudière, Joliette, Canada (S.K.); and St Vincent Hospital, Portland, Ore (J.G.).
Correspondence to Dr Gilles R. Dagenais, Institut universitaire de cardiologie et de pneumologie, Hôpital Laval, 2725, Chemin Ste-Foy, Ste-Foy, Québec, Canada, G1V 4 G5. E-mail Dagenaisgetr{at}hotmail.com
Background— In trials of patients with left ventricular dysfunction or heart failure, ACE inhibitor use was unexpectedly associated with reduced myocardial infarction (MI). Using the Heart Outcomes Prevention Evaluation (HOPE) trial data, we tested prospectively whether ramipril, an ACE inhibitor, could reduce coronary events and revascularization procedures among patients with normal left ventricular function.
Methods and Results— In the HOPE trial, 9297 high-risk men and women, 
55 years of age with previous cardiovascular disease or diabetes plus 1 risk factor, were randomly assigned to ramipril (up to 10 mg/d), vitamin E (400 IU/d), their combination, or matching placebos. During the mean follow-up of 4.5 years, there were 482 (10.4%) patients with clinical MI and unexpected cardiovascular death in the ramipril group compared with 604 (12.9%) in the placebo group [relative risk reduction (RRR), 21% (95% CI) (11,30); P<0.0003]. Ramipril was associated with a trend toward less fatal MI and unexpected death [4.0% versus 4.7%; RRR, 16% (-3, 31)] and with a significant reduction in nonfatal MI [5.6% versus 7.2%; RRR, 23% (9,34)]. Risk reductions in MI were documented in participants taking or not taking ß-blockers, lipid lowering, and/or antiplatelet agents. Although ramipril had no impact on hospitalizations for unstable angina [11.9% versus 12.2%; RRR, 3% (-9,14)], it reduced the risk of worsening and new angina [27.2% versus 30.0%; RRR, 12% (5,18); P<0.0014] and coronary revascularizations [12.5% versus 14.8%; RRR, 18%; (8,26) P<0.0005].
Conclusions— In this high-risk cohort, ramipril reduced the risk of MI, worsening and new angina, and the occurrence of coronary revascularizations.
Key Words: myocardial infarction • angina • revascularization • coronary disease • angiotensin
This article has been cited by other articles:
 |
|
 |
|
  G. J Dubel and T. P Murphy The role of percutaneous revascularization for renal artery stenosis Vascular Medicine, May 1, 2008; 13(2): 141 - 156. [Abstract] [PDF]
|
|
|
|
 |
|
 M. E van der Elst, M. L Bouvy, C. J de Blaey, and A. de Boer Effect of drug combinations on admission for recurrent myocardial infarction Heart, October 1, 2007; 93(10): 1226 - 1230. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. J. Cooper and T. P. Murphy The Case for Renal Artery Stenting for Treatment of Renal Artery Stenosis Circulation, January 16, 2007; 115(2): 263 - 270. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Cotton, C. B. Aspy, J. Mold, and H. Stein Clinical Decision-Making in Blood Pressure Management of Patients with Diabetes Mellitus: An Oklahoma Physicians Resource/Research Network (OKPRN) Study. J Am Board Fam Med, May 1, 2006; 19(3): 232 - 239. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Al-Mallah, I. M. Tleyjeh, A. A. Abdel-Latif, and W. D. Weaver Angiotensin-Converting Enzyme Inhibitors in Coronary Artery Disease and Preserved Left Ventricular Systolic Function: A Systematic Review and Meta-Analysis of Randomized Controlled Trials J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1576 - 1583. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Demers, J. J. V. McMurray, K. Swedberg, M. A. Pfeffer, C. B. Granger, B. Olofsson, R. S. McKelvie, J. Ostergren, E. L. Michelson, P. A. Johansson, et al. Impact of Candesartan on Nonfatal Myocardial Infarction and Cardiovascular Death in Patients With Heart Failure JAMA, October 12, 2005; 294(14): 1794 - 1798. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. A. Daly, K. M. Fox, W. J. Remme, M. E. Bertrand, R. Ferrari, M. L. Simoons, and on behalf of the EUROPA investigators The effect of perindopril on cardiovascular morbidity and mortality in patients with diabetes in the EUROPA study: results from the PERSUADE substudy Eur. Heart J., July 2, 2005; 26(14): 1369 - 1378. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Z. Jaffe and M. E. Mendelsohn Angiotensin II and Aldosterone Regulate Gene Transcription Via Functional Mineralocortocoid Receptors in Human Coronary Artery Smooth Muscle Cells Circ. Res., April 1, 2005; 96(6): 643 - 650. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Adler, H. Huang, Z. Wang, J. Conetta, E. Levee, X. Zhang, and T. H. Hintze Endocardial endothelium in the avascular frog heart: role for diffusion of NO in control of cardiac O2 consumption Am J Physiol Heart Circ Physiol, July 1, 2004; 287(1): H14 - H21. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E van der Elst, H. Buurma, M. L Bouvy, and A. de Boer Drug Therapy for Prevention of Recurrent Myocardial Infarction Ann. Pharmacother., October 1, 2003; 37(10): 1465 - 1477. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Sleight PPOGRESS beyond HOPE and LIFE: The ONTARGET trial programme Eur. Heart J. Suppl., August 1, 2003; 5(suppl_F): F40 - F47. [Abstract] [PDF]
|
|
|
|
|
|
J. Genest and T. R. Pedersen Prevention of Cardiovascular Ischemic Events: High-Risk and Secondary Prevention Circulation, April 22, 2003; 107(15): 2059 - 2065. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Dhein, A. Kabat, A. Olbrich, P. Rosen, H. Schroder, and F.-W. Mohr Effect of Chronic Treatment with Vitamin E on Endothelial Dysfunction in a Type I in Vivo Diabetes Mellitus Model and in Vitro J. Pharmacol. Exp. Ther., April 1, 2003; 305(1): 114 - 122. [Abstract] [Full Text]
|
|
|
|
|
|
J. V. Linseman and M. R. Bristow Drug Therapy and Heart Failure Prevention Circulation, March 11, 2003; 107(9): 1234 - 1236. [Full Text] [PDF]
|
|
|
|
 |
|
 L. G. Futterman and L. Lemberg Seminal Changes in the Management of the Acute Coronary Event: Current Concepts Am. J. Crit. Care., January 1, 2003; 12(1): 73 - 76. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Asimakopoulos and T. Gourlay A review of anti-inflammatory strategies in cardiac surgery Perfusion, January 1, 2003; 18(1_suppl): 7 - 12. [Abstract] [PDF]
|
|
|
|
|
|
F. Enseleit, T.F. Luscher, and F. Ruschitzka Angiotensin-converting enzyme inhibition and endothelial dysfunction: focus on ramipril Eur. Heart J. Suppl., January 1, 2003; 5(suppl_A): A31 - A36. [Abstract] [PDF]
|
|
|
|
|
|
M. E. Bertrand, M. L. Simoons, K. A.A. Fox, L. C. Wallentin, C. W. Hamm, E. McFadden, P. J. De Feyter, G. Specchia, and W. Ruzyllo Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation Eur. Heart J., December 1, 2002; 23(23): 1809 - 1840. [Full Text] [PDF]
|
|
|
|
 |
|
 D. C. Schwenke, L. L. Rudel, M. G. Sorci-Thomas, and M. J. Thomas {alpha}-Tocopherol protects against diet induced atherosclerosis in New Zealand white rabbits J. Lipid Res., November 1, 2002; 43(11): 1927 - 1938. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Hilfiker, D. Hilfiker-Kleiner, M. Fuchs, K. Kaminski, A. Lichtenberg, H.-J. Rothkotter, B. Schieffer, and H. Drexler Expression of CYR61, an Angiogenic Immediate Early Gene, in Arteriosclerosis and Its Regulation by Angiotensin II Circulation, July 9, 2002; 106(2): 254 - 260. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. G Erdos Kinins, the long march--A personal view Cardiovasc Res, June 1, 2002; 54(3): 485 - 491. [Full Text] [PDF]
|
|
|
|
|
|
D. K. Potyk, A. H. Shlossberg, and S. Yusuf Ramipril and Risk of Diabetes JAMA, January 9, 2002; 287(2): 186 - 187. [Full Text] [PDF]
|
|