The HOPE (Heart Outcomes Prevention Evaluation) Study and its consequences.
The HOPE study was a 19 country, prospective randomized trial in which the ACE-inhibitor Ramipril but not Vitamin E significantly reduced the risk of future cardiovascular events in a high-risk population of men and women, including many with diabetes. The benefits were present in all sub-groups, independent of the presence or absence of diabetes, hypertension, evidence of cardiovascular disease, microalbuminuria, blood pressure lowering, the use of aspirin, lipid-lowering or antihypertensive medication. It provided clear evidence that Ramipril should safely and cost-effectively be used in individuals not known to have low ventricular ejection fraction or heart failure but at high-risk of cardiovascular events. It was also beneficial in patients with renal insufficiency, reducing progression of proteinuria and development of new microalbuminuria. It provided micro- and macrovascular benefits in people with diabetes, reduced the development of new cases of diabetes and showed a positive and graded association between the waist-to-hip ratio and the risk of developing diabetes. Sub-studies completed and on-going into the predictive role of natriuretic peptides, infectious and inflammatory markers, provide insight into possible mechanisms of action of Ramipril.
McQueen
M J
MJ
Hamilton Regional Laboratory Medicine Program, Department of Laboratory Medicine, St. Joseph's Hospital, Hamilton, Ontario. mcquemat@hhsc.ca
Lonn
E
E
Gerstein
H C
HC
Bosch
J
J
Yusuf
S
S
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D048909:Diabetes Complications / Q000517:prevention & control; D005260:Female; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D007249:Inflammation / Q000150:complications; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D009203:Myocardial Infarction / Q000517:prevention & control*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D017257:Ramipril / Q000627:therapeutic use*; D020521:Stroke / Q000517:prevention & control*; D016277:Ventricular Function, Left / Q000187:drug effects; D014810:Vitamin E / Q000627:therapeutic use*
D000806:Angiotensin-Converting Enzyme Inhibitors; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D014810:Vitamin E; D017257:Ramipril; D001241:Aspirin