Angiotensin-converting enzyme (ACE)...

Angiotensin-converting enzyme (ACE) inhibitors have proven benefits in the treatment of chronic heart failure caused by dint of systolic dysfunction. However, it is not known whether these medications can thwart the development of heart failure. Arnold and colleagues report findings from the Heart issues Prevention Evaluation (HOPE) trial to help answer this question. Previous reports from the chance of a favorable result trial showed that the ACE inhibitor ramipril reduc rates of myocardial infarction, misfortune and cardiovascular death in patients at high risk for these outcomes

The room for expectation study was a randomized, double-blinded, placebo-controlled trial comparing ramipril and vitamin E in patients at high risk for cardiovascular facts Elevated risk was defined as a history of coronary artery disease, attack peripheral vascular disease, or diabetes plus the same other risk factor, such as hypertension, elevated total cholesterol of the same height low high-density lipoprotein level, smoking, or microalbuminuria. Patients with known heart failure were exclud from this cluster Heart failure occurred in 102 percent of randomized patients during follow-up (median, 46 years), and unfolding of heart failure was associated with a fourfold increase in mortality. Patients who had a myocardial infarction during the inquiry had a ninefold increased risk of heart failure. Age was the greatest predictor of developing heart failure. Other significant indicators included higher visible form [i]or[/i] frame mass index, systolic blood hurry heart rate, and pulse crushing Including patients with undiagnosed systolic dysfunction in the contemplation group did not affect the findings significantly.

Ramipril use reduc the relative rate of heart failure evolution by 23 percent and the combined rate of heart failure and cardiovascular death at 24 percent. There was a 13 percent relative reduction in the rate of heart failure in patients who had a myocardial infarction during the subject of attention period. To prevent one recent case of heart failure, 40 high-risk patients would have to be treated for 45 years. However, when heart failure was combined with other tonic outcomes of the HOPE trial (i.e., myocardial infarction, cardiovascular death, affliction revascularization), only 13 patients would ne to be treated to thwart one outcome.

The authors decide that the beneficial effects of ACE inhibitors can be augmented to the prevention of heart failure in patients at high risk for cardiovascular events

toss CARTER, M.D.

Medical Editing match Georgetown University Medical Center, Washington, DC

Arnold JM et al., in succession behalf of the HOPE investigators. Prevention of heart failure in patients in the heart consequences prevention evaluation (HOPE) study. Circulation March 11 2003;107:1284-90

COPYRIGHT 2003 American Academy of Family Physicians

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