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A correction has been published: N Engl J Med 2000;342(18):1376.

Volume 342:145-153 January 20, 2000 Number 3 Next

	Full Text PDF Editorial by Francis, G. S. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article Related Article PubMed Citation

ABSTRACT

Background Angiotensin-converting–enzyme inhibitors improve the outcome among patients with left ventricular dysfunction, whether or not they have heart failure. We assessed the role of an angiotensin-converting–enzyme inhibitor, ramipril, in patients who were at high risk for cardiovascular events but who did not have left ventricular dysfunction or heart failure.

Methods A total of 9297 high-risk patients (55 years of age or older) who had evidence of vascular disease or diabetes plus one other cardiovascular risk factor and who were not known to have a low ejection fraction or heart failure were randomly assigned to receive ramipril (10 mg once per day orally) or matching placebo for a mean of five years. The primary outcome was a composite of myocardial infarction, stroke, or death from cardiovascular causes.

The trial was a two-by-two factorial study evaluating both ramipril and vitamin E. The effects of vitamin E are reported in a companion paper.

Results A total of 651 patients who were assigned to receive ramipril (14.0 percent) reached the primary end point, as compared with 826 patients who were assigned to receive placebo (17.8 percent) (relative risk, 0.78; 95 percent confidence interval, 0.70 to 0.86; P<0.001). Treatment with ramipril reduced the rates of death from cardiovascular causes (6.1 percent, as compared with 8.1 percent in the placebo group; relative risk, 0.74; P<0.001), myocardial infarction (9.9 percent vs. 12.3 percent; relative risk, 0.80; P<0.001), stroke (3.4 percent vs. 4.9 percent; relative risk, 0.68; P<0.001), death from any cause (10.4 percent vs. 12.2 percent; relative risk, 0.84; P=0.005), revascularization procedures (16.0 percent vs. 18.3 percent; relative risk, 0.85; P=0.002), cardiac arrest (0.8 percent vs. 1.3 percent; relative risk, 0.63; P=0.03), heart failure (9.0 percent vs. 11.5 percent; relative risk, 0.77; P<0.001), and complications related to diabetes (6.4 percent vs. 7.6 percent; relative risk, 0.84; P=0.03).

Conclusions Ramipril significantly reduces the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients who are not known to have a low ejection fraction or heart failure.

Source Information

The writing group (Salim Yusuf, D.Phil., Peter Sleight, D.M., Janice Pogue, M.Sc., Jackie Bosch, M.Sc., Richard Davies, Ph.D., and Gilles Dagenais, M.D.) assumes responsibility for the overall content and integrity of the manuscript.

Address reprint requests to Dr. Salim Yusuf at the Canadian Cardiovascular Collaboration Project Office, Hamilton General Hospital, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada, or at hope{at}ccc.mcmaster.ca.

Full Text of this Article

Related Letters:

Effect of Ramipril on Cardiovascular Events in High-Risk Patients
Weinsaft J. W., O'Rourke M. F., Nichols W. W., Sharma A. M., Pischon T., Engeli S., Gavras H., Yusuf S., Francis G. S.
Extract | Full Text  
N Engl J Med 2000; 343:64-66, Jul 6, 2000. Correspondence

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