- Paper Report
- Open Access
Ramipril reduces mortality in patients at high risk of heart failure
- Adrian Steele
© Current Science Ltd 1999
- Published: 14 December 1999
- ACE inhibitor
- cardiovascular mortality
- randomised controlled trial
ACE inhibitors improve outcome in patients with low ejection fraction, heart failure and following myocardial infarction. There has been uncertainty concerning their benefit to patients at high risk of coronary artery disease.
The aim of this study was to assess the effect of ramipril in a broader group of patients with, or at high risk of, cardiovascular disease but without known heart failure or low ejection fraction.
The study was a double blind randomised comparison of ramipril (10 mg per day) vs placebo. Patients over 55 years of age with known coronary artery disease, stroke, or peripheral vascular disease or with diabetes and one major risk factor were included. Patients who were taking an ACE inhibitor, or who had impaired left ventricular function or other indication for an ACE inhibitor, were excluded. Primary end-points were the occurrence of myocardial infarction, stroke or death from cardiovascular causes. The secondary end-points included death from any cause and manifestations of worsening coronary artery disease.
Patient groups were well matched at baseline. Follow-up was for up to 4 years. In total, 653 patients (14.1 %) reached a primary end-point in the ramipril group, compared with 824 in the placebo group (17.7 %; relative risk = 0.78; 95% CI 0.70 - 0.86; p< 0.0001). There were also highly significant reductions in deaths from cardiovascular causes (6.1 % vs 8.l %), any cause (10.4 % vs 12.2 %) and in myocardial infarctions, cardiac arrests and a number of other secondary end-points.
The magnitude of benefit of ramipril in this broad group of patients is comparable to that from other interventions such as aspirin, beta-blockers and lipid lowering agents. The benefit was not explained by reduction in blood pressure: direct effects of ACE inhibition on the heart and vasculature are possible explanations. The result is unlikely to have been affected by the inclusion of patients with undiagnosed left ventricular dysfunction.