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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 33 times in current journal
articles indexed by ISI during November-December 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:
September-October 2001: 21 citations
July-August 2001: 26
May-June 2001: 34
March-April 2001: 28
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: 202
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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