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"Effects of angiotensin-converting-enzyme
inhibitor, ramipril, on cardiovascular events in high risk patients,"
by Salim Yusuf and 6 others, for the Heart Outcomes Prevention Evaluation
Study investigators, New England Journal of Medicine, 342(3):145-53, 20
January 2000.
[Authors' affiliation (project office):
Hamilton General Hospital, Ontario, Canada]
Abstract: Background.
Angiotensin-converting-enzyme inhibitors improve the outcome among patients
with left ventricular dysfunction, whether or not they have heart failure. We
assessed the role of angiotensin-converting-enzyme inhibitor, ramipril, in
patients who were at high risk for cardiovascular events but who did not have
left ventricular dysfunction or heart failure. Methods. A total
of 9297 high-risk patients (55 years of age or older) who had evidence of
vascular disease or diabetes plus one other cardiovascular risk factor and who
were not known to have a low ejection fraction or heart failure were randomly
assigned to receive ramipril (10 mg once per day orally) or matching placebo
for a mean of five years. The primary outcome was a composite of myocardial
infarction, stroke, or death from cardiovascular causes. The trial was a
two-by-two factorial study evaluating both ramipril and vitamin E. The effects
of vitamin E are reported in a companion paper. Results. A total
of 651 patients who were assigned to receive ramipril (14.0 percent) reached
the primary end point, as compared with 826 patients who were assigned to
receive placebo (17.8 percent) (relative risk, 0.78; 95 percent confidence
interval, 0.70 to 0.86;P<0.001). Treatment with ramipril reduced the rates
of death from cardiovascular causes (6.1 percent, as compared with 8.1 percent
in the placebo group; relative risk, 0.74;P<0.001), myocardial infarction
(9.9 percent vs. 12.3 percent; relative risk, 0.80; P<0.001), stroke (3.4
percent vs. 4.9 percent; relative risk, 0.68; P<0.001), death from any
cause (10.4 percent vs. 12.2 percent; relative risk, 0.84; P=0.005),
revascularization procedures (16.0 percent vs. 18.3 percent; relative risk,
0.85; P=0.002), cardiac arrest (0.8 percent vs. 1.3 percent; relative risk,
0.63; P=0.03), heart failure (9.0 percent vs. 11.5 percent; relative risk,
0.77; P<0.001), and complications related to diabetes (6.4 percent vs 7.6
percent; relative risk, 0.84; P=0.03). Conclusions. Ramipril
significantly reduces the rates of death, myocardial infarction, and stroke in
a broad range of high-risk patients who are not known to have a low ejection
fraction or heart failure."
This 2000 report from the New England
Journal of Medicine was cited 34 times in current journal
articles indexed by ISI during May-June 2001. No other paper in medicine
published in the last two years, aside from reviews, collected more citations
during that two-month period. Prior to the most recent bimonthly count,
citations to the paper have accrued as follows:
March-April 2001: 28 citations
January-February 2001: 19
November-December 2000: 15
September-October 2000: 13
July-August 2000: 8
May-June 2000: 3
March-April 2000: 2
Total citations to date: 122
SOURCE: Hot
Papers Database (Available from the ISI
Research Services Group in a CD-ROM version containing data on
hundreds of highly cited papers published during the last two years.
User interface permits searching by author, organization, journal,
field, and more. Total citations, as well as citations accrued during
successive bimonthly periods, can be assessed and graphed. Database is
combined with subscription to the ISI newsletter Science
Watch®; updated discs containing the
most recent bimonthly data are mailed with each new issue, six times a
year.)
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