Effects of an angiotensin-converting enzyme inhibitor (ramipril) on inflammatory markers in secondary prevention patients: RAICES Study.
OBJECTIVE
To evaluate the hypothesis that angiotensin-converting enzyme inhibitor therapy with ramipril reduces baseline levels of C-reactive protein in patients at high cardiovascular risk.


METHODS
Secondary prevention patients were screened for eligibility and treated with ramipril for 6 month. Baseline and 6-month highly sensitive C-reactive protein levels were determined.


RESULTS
A total of 77 patients were analyzed. The median highly sensitive C-reactive protein concentration at baseline was 2.17 mg/l (interquartile interval 0.97-4.54); whereas in post-treatment, the median was 1.70 mg/l (interquartile interval 0.88-3.41), P=0.0009. Patients were stratified according to risk level determined by baseline highly sensitive C-reactive protein levels: low-risk (<1 mg/l), intermediate risk (1-3 mg/l) and high risk (>3 mg/l) The reduction in highly sensitive C-reactive protein occurred at the expense of the high-risk group (baseline 5.02 mg/l, post-treatment 3.3 mg/l, P<0.0001), with no differences in the other groups. In multiple regression analysis, the reduction observed in the high-risk group could not be explained by baseline treatment or change in any of the variables analyzed.


CONCLUSIONS
Highly sensitive C-reactive protein levels were reduced after a 6-month ramipril therapy in secondary prevention patients, suggesting an anti-inflammatory effect of angiotensin-converting enzyme inhibitors. Future investigations will be done to confirm these results, and to investigate how angiotensin-converting enzyme inhibitor treatment elicits anti-inflammatory effects.
Lopez Santi
Ricardo G
RG
PROCORDIS, Fundación Bioquímica Argentina, La Plata, Argentina. procordis@fba.org.ar
Valeff
Eduardo C
EC
Duymovich
Claudio R
CR
Mazziotta
Daniel
D
Mijailovsky
Norma E
NE
Filippa
Gerardo C
GC
Maltez
Raúl
R
Hernandez
Violeta A
VA
Monroy
Alejandro Gomez
AG
Borzi
Jorge G
JG
Acheme
Rosana A
RA
Etchegoyen
María C
MC
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D002097:C-Reactive Protein / Q000032:analysis / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007249:Inflammation / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D017257:Ramipril / Q000494:pharmacology*; D012307:Risk Factors; D055502:Secondary Prevention
D000806:Angiotensin-Converting Enzyme Inhibitors; D002097:C-Reactive Protein; D017257:Ramipril