The drug ramipril cuts the rate of sudden cardiac death and nonfatal cardiac arrest by 21 percent in
people at high risk of heart attack or stroke.
That's
the conclusion of a Canadian study in the Sept. 7 issue of Circulation.
Ramipril
is an angiotensin-converting enzyme (ACE) inhibitor, a class of drugs often used to treat heart failure or left ventricular
systolic dysfunction. But none of the patients in this study had either condition, the study authors noted.
The
researchers analyzed data on 9,297 men and women, average age 66, at high risk for heart attack or stroke who enrolled in
the Heart Outcomes Prevention Evaluation (HOPE) study. They were randomly assigned to take either ramipril, vitamin E or a
placebo.
After
an average of 4.5 years of treatment, 3.3 percent of the people taking ramipril had suffered either sudden cardiac death or
nonfatal cardiac arrest, compared to 4.2 percent of those taking the placebo. There was no significant difference in the outcomes
between those taking vitamin E and those taking the placebo.
Previous
studies also found similar protective effects for other ACE inhibitors.
"The
new findings should remind physicians of the importance of ACE inhibitor therapy. We now know that these drugs are not only
good in preventing overall cardiovascular death, but also in preventing specific causes of death," study lead author Koon
K.Teo, a professor of medicine at McMaster University in Hamilton, said in a prepared statement.
The
study received funding from Aventis Pharma Inc., which manufactures ramipril.
More
information
The American Heart Association has more about heart attack.
23%
reduction by aspirin (P < 0.0001)
Each of these early trials suggested a beneficial effect of aspirin, but the
results of none achieved an acceptable level of statistical significance. Overall, however, there is clearly convincing evidence
of benefit.
The reporting of overviews of the results from all relevant published trials relating to a particular
clinical intervention is becoming increasingly common throughout clinical practice and the first such overview, or meta-analysis,
based on these six trials was presented by Richard Peto and his colleagues of Oxford to the inaugural meeting of the Society
for Clinical Trials in Philadelphia in 1980.(31)
This overview was one strand in the thinking that led eventually
to the setting up of the Cochrane Collaboration, the worldwide initiative that aims to conduct overviews within every area
of clinical activity. (32)
Since
that first report, the Oxford group have produced several monumental overviews of aspirin and cardiovascular disease: in 1988
(33) ,1994 (34). and 1997 (35).
The
following is based on the overview published in 1994, which combines results from 145 RCTs, with a total of 102,459 patients
and 10,943 outcome events. A remarkably consistent reduction in vascular events is demonstrated (22 to 32%).
An overview
of RCT's of aspirin and cardiovascular disease
(BMJ
1994;308:81-106)
BMJ
is the British Journal of Medicine, one of a small group of top rated medical journals.--jk
