The ACE inhibitor ramipril is beneficial in a broad range of patients without evidence of heart failure who are at high risk of cardiovascular events, say the authors of the HOPE (Heart Outcomes Prevention Evaluation) study. They report that treatment with the drug (10mg daily) reduced death, myocardial infarction, stroke and heart failure, as well as the risk of complications related to diabetes, and of diabetes itself. The results, which will be published in the New England Journal of Medicine on January 20, were first released at the European Society of Cardiology conference in August (PJ, September 4, p338).
However, the journal has released the data early on its internet site (www.nejm.org) "because of the potential therapeutic implications." HOPE involved patients who had a history of coronary artery disease, stroke, peripheral vascular disease, or diabetes plus at least one other cardiovascular risk factor. The primary outcome of the trial (MI, stroke or death from cardiovascular causes) was reached by 653 ramipril patients (14.1 per cent) and 824 placebo patients (17.7 per cent).