Effect of long-term therapy with ramipril in high-risk women

We evaluated the effects of long-term therapy with the angiotensin-converting enzyme (ACE) inhibitor ramipril on major cardiovascular (CV) outcomes in high-risk women. The effect of long-term ACE inhibitor therapy in high-risk women without heart failure and with preserved left ventricular (LV) syst...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2002-08, Vol.40 (4), p.693-702
Main Authors: Lonn, Eva, Roccaforte, Rosa, Yi, Qilong, Dagenais, Gilles, Sleight, Peter, Bosch, Jackie, Suhan, Pamela, Micks, Mary, Probstfield, Jeffrey, Bernstein, Victoria, Yusuf, Salim
Format: Article
Language:English
Subjects:
Aged
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Biological and medical sciences
Cardiology
Cardiovascular disease
Cardiovascular Diseases - drug therapy
Cardiovascular Diseases - mortality
Cardiovascular Diseases - prevention & control
Cardiovascular system
Diabetes
Drug therapy
Enzymes
Female
Follow-Up Studies
Heart attacks
Heart failure
Hospitalization
Humans
Hypertension
Medical sciences
Middle Aged
Miscellaneous
Myocardial Infarction - epidemiology
Older people
Pharmacology. Drug treatments
Ramipril - therapeutic use
Randomized Controlled Trials as Topic
Risk Factors
Stroke
Stroke - epidemiology
Studies
Treatment Outcome
Women
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Summary:We evaluated the effects of long-term therapy with the angiotensin-converting enzyme (ACE) inhibitor ramipril on major cardiovascular (CV) outcomes in high-risk women. The effect of long-term ACE inhibitor therapy in high-risk women without heart failure and with preserved left ventricular (LV) systolic function has not been previously reported. The Heart Outcomes Prevention Evaluation (HOPE) trial is a large, randomized clinical trial that evaluated ramipril and vitamin E in high-risk patients. We present the preplanned analysis of the effects of ramipril in women in the HOPE study. The study randomized 2,480 women aged ≥55 years with vascular disease or diabetes and at least one additional CV risk factor and without heart failure or a known low LV ejection fraction to ramipril (10 mg/day) or placebo. The primary outcome was the composite of myocardial infarction, stroke or CV death. Average follow-up was 4.5 years. Treatment with ramipril resulted in reduced primary end point rates (11.3% vs. 14.9% in the placebo arm; relative risk [RR] 0.77, 95% confidence interval [CI] 0.62 to 0.96; p = 0.019), fewer strokes (3.1% vs. 4.8%; RR 0.64, 95% CI 0.43 to 0.96; p = 0.029) and fewer CV deaths (4.2% vs. 6.9%; RR 0.62, 95% CI 0.44 to 0.88; p = 0.0068). There were trends toward reduced rates of myocardial infarction, heart failure and all-cause death. The beneficial effect of ramipril was similar in women and men. Treatment with ramipril reduces the CV risk in high-risk women without heart failure and with preserved LV systolic function.
ISSN:0735-1097
1558-3597
DOI:10.1016/S0735-1097(02)02035-1