1. Effects of ramipril and vitamin E on atherosclerosis: the study to evaluate carotid ultrasound changes in patients treated with ramipril and vitamin E (SECURE).
- Author
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Lonn E, Yusuf S, Dzavik V, Doris C, Yi Q, Smith S, Moore-Cox A, Bosch J, Riley W, and Teo K
- Subjects
- Aged, Analysis of Variance, Arteriosclerosis blood, Arteriosclerosis complications, Arteriosclerosis diagnostic imaging, Blood Pressure drug effects, Carotid Artery Diseases blood, Carotid Artery Diseases complications, Carotid Artery Diseases diagnosis, Creatinine blood, Disease Progression, Double-Blind Method, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Compliance, Potassium blood, Prospective Studies, Risk Factors, Treatment Outcome, Ultrasonography, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Arteriosclerosis drug therapy, Carotid Artery Diseases drug therapy, Ramipril therapeutic use, Vitamin E therapeutic use
- Abstract
Background: Activation of the renin-angiotensin-aldosterone system and oxidative modification of LDL cholesterol play important roles in atherosclerosis. The Study to Evaluate Carotid Ultrasound changes in patients treated with Ramipril and vitamin E (SECURE), a substudy of the Heart Outcomes Prevention Evaluation (HOPE) trial, was a prospective, double-blind, 3x2 factorial design trial that evaluated the effects of long-term treatment with the angiotensin-converting enzyme inhibitor ramipril and vitamin E on atherosclerosis progression in high-risk patients., Methods and Results: A total of 732 patients >/=55 years of age who had vascular disease or diabetes and at least one other risk factor and who did not have heart failure or a low left ventricular ejection fraction were randomly assigned to receive ramipril 2.5 mg/d or 10 mg/d and vitamin E (RRR-alpha-tocopheryl acetate) 400 IU/d or their matching placebos. Average follow-up was 4.5 years. Atherosclerosis progression was evaluated by B-mode carotid ultrasound. The progression slope of the mean maximum carotid intimal medial thickness was 0.0217 mm/year in the placebo group, 0.0180 mm/year in the ramipril 2.5 mg/d group, and 0.0137 mm/year in the ramipril 10 mg/d group (P=0.033). There were no differences in atherosclerosis progression rates between patients on vitamin E and those on placebo., Conclusions: Long-term treatment with ramipril had a beneficial effect on atherosclerosis progression. Vitamin E had a neutral effect on atherosclerosis progression.
- Published
- 2001
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