Problem CAD, stroke, PVD or DM
Format Double-blinded multi-center RCT
Treatment Ramipril 10 +/- Vitamin E
Control Placebo
Population 9541 patients
Inclusion criteria 55 years or older
History of either:
Plus at least one other CV disease risk factor
-Elevated total cholesterole
-Elevated LDL
Exclusion criteria CCF
Ejection fraction < 40%
Already taking ACEi or Vitamin E
Uncontrolled HTN
Overt nephropathy
MI or stroke within 4 weeks of study start
Follow-up Mean 5 years
Primary endpoint Composite of death from cardiovascular causes, myocardial infarction, or stroke
Each of these outcomes separately
Secondary endpoint(s) Ceath from any cause
Need for revascularization, hospitalization for unstable angina or heart failure
Complications related to diabetes
Details .
Brief summary: Ramipril prevents new CCF in high risk patients
PAPER: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators.
Date 20 Jan 2000
Journal N Engl J Med. 2000 Jan 20;342(3):145-53.
Information Ramipril 10mg vs. placebo
-In high-risk patients not known to have CCF/EF <40%
-Dose increased over 4 weeks

Significantly reduced
-Composite of MI/CVA/CV death (14.0->17.8%; RR 0.78, P<0.001)
-All above in isolation, and revascularisation and DM complications
-New DM diagnoses
Drug well tolerated (28.9% permanent discontinuation vs. 27.3 (placebo))
PAPER: Vitamin E Supplementation and Cardiovascular Events in High-Risk Patients
Date 20 Jan 2000
Journal N Engl J Med. 2000 Jan 20;342(3):154-60.
Information Vitamin E vs. placebo
-No significant different in composite of MI/CVA/CV death
-No significant different in any endpoints in isolation
No adverse effects
PAPER: Prevention of Heart Failure in Patients in the Heart Outcomes Prevention Evaluation (HOPE) Study
Date 11 Mar 2003
Journal Circulation. 2003 Mar 11;107(9):1284-90.
Information Ramipril vs. Placebo
-Significantly reduced rates of new CCF
--Regardless of interim MI
-Increased benefit with SBP > 139 mmHg