By: Thomas Pickering, MD, DPhil, FRCP, Director of Integrative and Behavioral Cardiology Program
of the Cardiovascular Institute at Mount Sinai School of Medicine, New York.
The results of a new study (officially called the HOPE study) that showed beneficial effects of an ACE inhibitor (Altace or ramipril) were presented at the American Heart Association meeting in November 1999. The detailed results will be published in January 2000. More than 10,000 patients were enrolled, and had Altace or a dummy placebo added to their other medications and were followed for five years. To get into the study, the patients had to have known cardiovascular disease (a previous stroke or heart attack, for example) plus one other risk factor (high blood pressure, smoking, or high cholesterol).
The study was terminated early because the results of adding the ACE inhibitor were so strong. Death from any cause was reduced by 15% and from cardiovascular disease by 25%. The number of heart attacks was reduced by 20%, strokes by 30%, cases of heart failure by 20%, and bypass operations or angioplasties by 14%. The number of new cases of diabetes was also reduced.
Comments
This exciting result extends the known benefits from ACE inhibitors. Earlier studies have shown similar benefits in patients who have just recovered from a heart attack, and these results extend to a wider population. Only one study has focused on people with high blood pressure (CAPPP, which used captopril, and which we describe elsewhere) which did not show such strong benefits, although it did report a reduction of diabetes. The main implication of this study is that doctors should use ACE inhibitors (particularly Altace) more widely in patients at high risk of heart disease. Whether or not the results with Altace can be applied to other ACE inhibitors cannot be said, but so far the similarities between different drugs in this class are greater than the differences.
