Ramipril Benefits Patients at Risk of Cardiovascular Events

	September 2, 1999 - The 21st Congress of the European Society of
Cardiology is under way. Results of the HOPE (Heart Outcomes Prevention
Evaluation) trial were announced this week. HOPE trial data show that
treatment with ramipril cuts the risk of cardiovascular deaths, heart attack,
and stroke by 22% in patients at risk for such events.
	Dr. Salim Yusuf and others at 267 centers in North America, South
America and Europe compared the ACE inhibitor ramipril with placebo for
reducing cardiovascular events in at-risk patients. They also compared the
effects of vitamin E with placebo in decreasing risk of heart disease. The
trial included 9,541 people age 55 or older who had a history of coronary
artery disease or stroke.
	Ramipril decreased the risk of cardiovascular death by 25%, the
risk of nonfatal heart attack by 20% and the risk of nonfatal stroke by
32%. It also reduced the need for revascularization procedures by 15% and
the number of hospitalizations for CHF by 16%. The reduction in risk of
new-onset diabetes in the ramipril group was 30%. The benefits occurred
independent of age, gender, the presence or absence of high BP and coronary
artery disease.
	The HOPE study was designed to last 5 years but the ramipril/placebo
study was stopped 6 months early. An early review of the data showed a clear
decrease in cardiovascular deaths, heart attack and stroke for ramipril
compared with placebo.
	Dr. Yusuf reported that so far, the vitamin E results show no
measurable effect on heart disease prevention. According to him, this is
in line with the results of 2 prior studies that found a neutral effect on
cardiovascular deaths with almost 5 years of follow-up. The vitamin E/placebo
part of the study will continue for several more years to study the long-term
effect of vitamin E on heart disease.