Interpreting Key Trials
Ramipril lowered cardiovascular risk, but vitamin E did not
The HOPE study
Cleveland Clinic Journal of Medicine. 2000 April;67(4):287-293
Author and Disclosure Information
Byron J. Hoogwerf, MD
Department of Endocrinology, Director, Internal Medicine Residency Program, Cleveland Clinic; investigator, Heart Outcomes Prevention Evaluation (HOPE) study
James B. Young, MD
Head, Section of Heart Failure and Cardiac Transplant Medicine, Department of Cardiology, Cleveland Clinic; member, steering committee, Heart Outcomes Prevention Evaluation (HOPE) study
Address: Byron J. Hoogwerf, MD, Department of Endocrinology, A30, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; hoogweb@ccf.org
This paper discusses off-label uses of medication. The HOPE study was funded by the Medical Research Council of Canada, Hoechst-Marion Roussel, AstraZeneca, King Pharmacuticals, Natural Source Vitamin E Association, Negma, and the Heart and Stroke Foundation of Ontario.
Drs. Hoogwerf and Young serve as consultants for Monarch Pharmaceuticals.
ABSTRACT
The Heart Outcomes Prevention Evaluation (HOPE) study found that the ACE inhibitor ramipril can lower the risk of atherosclerotic disease events and death in patients without heart failure but with known atherosclerosis or with diabetes plus at least one cardiovascular risk factor. This benefit was independent of ramipril's effect on blood pressure. Additional benefits were a reduced risk of diabetic nephropathy in diabetic patients, and a lower likelihood of newly diagnosed diabetes. On the other hand, vitamin E in the doses and duration studied (400 IU/day for 4.5 years) did not lower risk significantly.