EFFECT OF LONG-TERM ACE-INHIBITOR THERAPY IN ELDERLY VASCULAR DISEASE PATIENTS

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.