European Heart Journal Advance Access originally published online on March 29, 2007
European Heart Journal 2007 28(11):1382-1388; doi:10.1093/eurheartj/ehm017
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Effect of long-term ACE-inhibitor therapy in elderly vascular disease patients
1 Department of Medicine, University of Insubria, Varese, Italy
2 Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
3 University of Washington, Seattle, Washington, USA
4 Laval University, Quebec, Canada
5 Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ontario, Italy
Received 2 October 2006; revised 11 February 2007; accepted 15 February 2007; online publish-ahead-of-print 29 March 2007.
* Corresponding author: Hamilton Health Sciences Corporation, General Site, 237 Barton Street East, Hamilton, ON, Canada L8L 2X2. Tel: +1 905 526 0970; fax: +1 905 527 5380. E-mail address: lonnem{at}mcmaster.ca
See page 1277 for the editorial comment on this article (doi:10.1093/eurheartj/ehm017)
Aims: Cardiovascular (CV) disease is the leading cause of death in the elderly. The use of ACE-inhibitors in elderly patients with chronic stable vascular disease has not been previously reported.
Methods and results: The HOPE trial evaluated the effects of ramipril and vitamin E in high-risk vascular disease patients. We report the effects of ramipril in the elderly HOPE study patients, defined as those 
70 years of age. A total of 2755 elderly patients with vascular disease or diabetes and at least one additional CV risk factor and without heart failure or low ejection fraction were randomized to ramipril 10 mg daily or placebo. Those assigned to ramipril had fewer major vascular events compared to those assigned to placebo [18.6 vs. 24.0%, hazard ratio (HR) = 0.75, P = 0.0006], CV deaths (9.3 vs. 13.0%, HR = 0.71, P = 0.003), myocardial infarctions (12.0 vs. 15.6%, HR = 0.75, P = 0.006), and strokes (5.4 vs. 7.7%, HR = 0.69, P = 0.013). Treatment was safe and generally well tolerated.
Conclusion: Ramipril reduces the risk of major vascular events in elderly patients with vascular disease and is safe and well tolerated by most.
Key Words: Cardiovascular disease • Myocardial infarction • Stroke • Age • ACE-inhibitor
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- Cardiovascular disease and the elderly: can the evidence base avoid irrelevance?
- Pamela N. Peterson and Frederick A. Masoudi
EHJ 2007 28: 1277-1278.[Extract] [Full Text]
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  P. N. Peterson and F. A. Masoudi Cardiovascular disease and the elderly: can the evidence base avoid irrelevance? Eur. Heart J., June 1, 2007; 28(11): 1277 - 1278. [Full Text] [PDF]
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