HOPE and MICRO-HOPE: review of the results and implications for people with diabetes

Abstract

Cardiovascular disease remains the commonest cause of mortality in people with diabetes. Previous attempts to reduce the burden of heart disease in people with diabetes have tended to concentrate on the reduction of conventional cardiovascular risk factors, and less attention has been paid to wider aspects of cardiovascular disease in this group of people. The Heart Outcomes Prevention Evaluation (HOPE) study was a large, randomized trial with wide entry criteria which examined the hypothesis that ACE inhibition using ramipril would reduce cardiovascular events in patients at high risk who would not previously be treated with ACE inhibitors. Diabetes was a pre-defined subgroup, and over three thousand patients with diabetes were recruited who had evidence of vascular disease, or had diabetes and one other cardiovascular risk factor (cholesterol > 5.2, hypertension, microalbuminuria, smoking). The study was discontinued prematurely because of a significant reduction in the composite primary end-point of myocardial infarction, stroke, and death from cardiovascular disease. In the diabetic patients the primary event rate of the combination of myocardial infarction, stroke and cardiovascular death was reduced by a quarter in patients on ramipril, and this reduction was seen both in patients with and without previous cardiovascular disease. The benefit was greater than could be accounted for by the minor decrease in blood pressure, suggesting wider effects on the cardiovascular system. Ramipril also reduced the development of overt nephropathy in diabetic subjects with microalbuminuria. Ramipril should be considered for diabetic patients with existing cardiovascular disease, or who have a high risk of disease because of the presence of cardiovascular risk factors. Copyright 2001 Harcourt Publishers Ltd Copyright 2001 Harcourt Publishers Ltd doi: 10.1054/chec.2001.0111, available online at http://www.idealibrary.com on