Effects of ramipril and vitamin E on atherosclerosis - The study to evaluate carotid ultrasound changes in patients treated with ramipril and vitaminE (SECURE)

Background-Activation of the renin-angiotensin-aldosterone system and oxida tive modification of LDL cholesterol play important roles in atherosclerosi s. The Study to Evaluate Carotid Ultrasound changes in patients treated wit h Ramipril and vitamin E (SECURE), a substudy of the Heart Outcomes Prevent ion Evaluation (HOPE) trial, was a prospective, double-blind, 3X2 factorial design trial that evaluated the effects of long-term treatment with the an giotensin-converting enzyme inhibitor ramipril and vitamin E on atheroscler osis progression in high-risk patients, Methods mid Results-A total of 732 patients greater than or equal to 55 yea rs 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 ejectio n fraction were randomly assigned to receive ramipril 2.5 mg/d or 10 mg/d a nd vitamin E (RRR-alpha -tocopheryl acetate) 400 IU/d or their matching pla cebos. Average follow-up was 4.5 years. Atherosclerosis progression was eva luated by B-mode carotid ultrasound. The progression slope of the mean maxi mum carotid intimal medial thickness was 0.0217 mm/year in the placebo grou p, 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 atheroscler osis progression rates between patients on vitamin E and those on placebo. Conclusions-Long-term treatment with ramipril had a beneficial effect on at herosclerosis progression. Vitamin E had a neutral effect on atherosclerosi s progression.