Heart Outcomes Prevention Evaluation trial

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. 

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. ... 

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... 

Another class of vasoactive agents with demonstrated benefit in secondary MI prevention are the angiotensin-con-verting enzyme (ACE) inhibitors. Several large trials of angiotensin receptor blockers as secondary prevention agents are now also underway. Most of the evidence for benefit from ACE inhibitors has centered on patients with heart failure (59). An exception to this was the Heart Outcomes Prevention Evaluation (HOPE) trial, which excluded patients with ejection fractions <40%, and involved 9297 patients (60). There was a 25% reduction in cardiac mortality in patients receiving the ACE inhibitor ramipril. 

The ability of a-tocopherol supplementation to prevent cardiovascular events in different populations was tested in four larger prospective clinical trials The a-Tocopherol, yS-Carotene Cancer Prevention (ATBC) study, the Cambridge Heart Antioxidant Study (CHAOS), the Gruppo Italiano per lo studio della Sopravvivenza nell Infarto Miocar-dito (GISSI) trial, and the Heart Outcome Prevention Evaluation (HOPE) study. In addition, at least two smaller prospective clinical trials have been completed the Secondary Prevention with... 

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