Heart Outcomes Prevention

Heart Outcomes Prevention Evaluation Study Investigators. Effects of ramipril on cardiovascular and mi-crovascular outcomes in people with diabetes melli-tus results of the HOPE study and MICRO-HOPE substudy. Lancet 2000 355 253-9. 

Abbreviations. CAD. coronary artery diseases CVA, cerebrovascular accident HOPE, heart outcomes prevention evaluation LTA. light transmittance aggregometry MI. myocardial infarction PCI. percutaneous coronary intervention PVD. peripheral vascular diseases RPFA, rapid platelet function analyzer TxB2, thromboxane B2. 

In the Heart Outcomes Prevention Evaluation 2 (HOPE-2) study, 5522 patients aged 55 or older with vascular disease or diabetes were randomized to treatment with either placebo or a combination 2, 5 mg of folic acid, 50 mg vitamin B6, and I mg vitamin B 2, for an average of five years. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, and stroke. Mean plasma homocysteine levels decreased by 2.4 jimol/L in the treatment group and increased by 0.8 jimol/L in the placebo group. The primary outcome occurred in 18.8% of patients assigned to active therapy and in 19.8% of those assigned to placebo (relative risk = 0.95 95% Cl = 0.84-1.07 P = 0.41) (68). 

Cambridge Heart Antioxidant Study DATATOR Deprenyl and Tocopherol Antioxidative Therapy of Rarkinsonism FMC, Finnish Mobile Clinic Health Examination Survey GISSI, Gruppo Italiano Studio Soprawivenza Infarto HOPE, Heart Outcome Prevention Evaluation HPFS, Health Professional Follow-up Study NHS, Nurses Health Study PPR Primary Prevention Project SPACE, Secondary Prevention with Antioxidants of Cardiovascular disease in End-stage renal disease VEAPS, Vitamin E Atherosclerosis Prevention Study VECAT Vitamin E Cataract Age-related maculopathy Trial. 

Yusuf S, Dagenais G, Pogue J, et al. Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000 342 154-160. 

The Heart Outcomes Prevention Evaluation (HOPE) Study Investigators (2000). Lancet 355, 253-259. 

In addition to their benefits in patients with established heart failure, ACE inhibitors also are effective for prevention of heart failure. The SOLVD prevention trial showed that enalapril decreased the risk of hospitalization for worsening heart failure and reduced the composite end point of death and heart failure hospitalization in patients with asymptomatic left ventricular dysfunction. The development of diabetes mellitus, an important risk factor for cardiovascular disease that also increases morbidity and mortality in heart failure patients, is reduced by enalapril in patients with chronic heart failure. In a post-hoc analysis of the Heart Outcomes Prevention Evaluation (HOPE) trial, ramipril reduced the development of new-onset heart failure by nearly 25% in patients with normal EFs and no symptoms of heart failure. ... 

Dagenais GR, Yusuf S, Bourassa MG, et al. Effects of ramipril on coronary events in high-risk persons Results of the Heart Outcomes Prevention Evaluation Smdy. Circulation 2001 104 522-526. 

More recent data suggest that all patients with CAD, not just ACS or heart failure patients, benefit from an ACE inhibitor. In the Heart Outcome Prevention Evaluation (HOPE) trial, ramipril significantly reduced the risk of death, MI, or stroke in high-risk patients aged 55 years or older with chronic CAD or with diabetes and one cardiovascular risk factor. The more recent European trial On Reduction Of Cardiac Events With Perindopril In Stable Coronary Artery Disease (EUROPA) extended the benefit of chronic therapy with ACE inhibitors to patients with stable CAD at lower risk of cardiovascular events compared with patients from the HOPE trial. In the EUROPA trial, patients randomized to perindopril experienced a lower risk of the combined end point of cardiovascular death, MI, or cardiac arrest compared with patients randomized to placebo. Therefore, based on the extensive benefit of ACE inhibitors in patients with CAD, their routine use should be considered in all patients following an ACS in the absence of a contraindication. 

EUROPA European trial On Reduction Of Cardiac Events With Perindopril In Stable Coronary Artery Disease GRACE Global Registry of Acute Coronary Events GUSTO Global Use of Strategies to Open Occluded Arteries HOPE Heart Outcomes Prevention Evaluation INR international normalized ratio... 

HOPE Heart Outcomes Prevention Evaluation study... 

Anon. Effects of ramipril on cardiovascular and microvas-cular outcomes in people with diabetes meUitus Results of the hope study and micro-hope substudy. Heart outcomes prevention evaluation study investigators. Lancet. 2000 355 253-259... 

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