Effect of long-term therapy with ramipril in high-risk women.
OBJECTIVE
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.
Department of Medicine, Division of Cardiology and Population Health Institute, McMaster University, Hamilton, Ontario, Canada. lonnem@mcmaster.ca
Eva
E
Lonn
Rosa
R
Roccaforte
Qilong
Q
Yi
Gilles
G
Dagenais
Peter
P
Sleight
Jackie
J
Bosch
Pamela
P
Suhan
Mary
M
Micks
Jeffrey
J
Probstfield
Victoria
V
Bernstein
Salim
S
Yusuf
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D017257:Ramipril / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D017257:Ramipril