Abstract 3498: Neither Ramipril Nor Vitamin E Reduces the Incidence of Atrial Fibrillation. Results of the HOPE Study.
Background: Atrial fibrillation (AF)is associated with significant morbidity and mortality. Although a number of important risk factors for development of AF have been identified, its pathophysiology is still not clear. Recently, the role of angiotensin receptor in the development of AF has been suggested with a number of clinical studies showing potential benefit of angiotensin blockade either at the receptor level or inhibiting the converting enzyme. We set out to test this hypothesis using data from HOPE study.
Methods: ECGs (at baseline, 2 years, and end of study) from 8334 pts enrolled in the HOPE study who were in sinus rhythm at enrollment were analyzed. The HOPE study enrolled patients aged ≥55 yrs with previous cardiovascular disease, or diabetes plus one risk factor, no clinical evidence of heart failure, and preserved LV systolic function, randomized to one of ramipril, vitamin E, their combination, or matching placebos.
Results: Of the 8334 pts who were in sinus rhythm at enrollment, 177 (2.1%) developed AF over the followup period of 4.5 yrs. There was no statistically significant difference in the proportion of pts who develped AF in the ramipril and placebo groups (2.0% vs 2.2%, p=NS). Univariate predictors of AF development were age, systolic BP, history of hypertension, body mass index (BMI) and microalbuminuria. On multivariate logistic regression analysis only age (OR 1.55, 1.33–1.80, p<0.01), BMI (OR 1.21, 1.05–1.42, p=0.01), and microalbuminuria (OR 1.50, 1.07–2.11, p=0.02) were independent predictors of development of AF. Ramipril had no protective effect on development of AF (OR 0.92, 0.68–1.24, p=0.57). Vitamin E also showed no protective effect on the development of new AF (OR 0.86, 0.64–1.16, p=0.33).
Conclusions: In high risk population use of the ACE inhibitor ramipril or Vitamin E does not reduce the incidence of new onset AF.