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

J Am Coll Cardiol. 2002 Aug 21;40(4):693-702. doi: 10.1016/s0735-1097(02)02035-1.

Abstract

Objectives: 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.

Background: 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.

Methods: 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 >or=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.

Results: 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.

Conclusions: Treatment with ramipril reduces the CV risk in high-risk women without heart failure and with preserved LV systolic function.

Publication types

  • Clinical Trial
  • Evaluation Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Cardiovascular Diseases / drug therapy
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / prevention & control*
  • Female
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Ramipril / therapeutic use*
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Stroke / epidemiology
  • Treatment Outcome

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Ramipril