Reports of some exciting new drug approaches to treating cardiovascular disease, based on clinical trials, marked this year's meeting of the American Heart Association, held in Atlanta.
Among the clinical efforts was HOPE (Heart Outcomes Prevention Evaluation). The trial showed a 22% relative risk reduction in heart attack, stroke, and death from cardiovascular disease in those taking the ACE inhibitor Altace (ramipril, Hoechst Marion Roussel) 10 mg/ day, compared with placebo. Another arm of the study randomized patients to 400 mg daily of vitamin E or placebo; no advantage was shown for vitamin E at that point in time.
HOPE, begun in 1994, involved 267 centers in 19 countries, including the United States, Canada, Europe, and South America. Not quite half of the patients were hypertensive, but benefits of the drug were seen in the normotensives as well, according to study chairman Salim Yusuf, M.D., professor of medicine at McMaster University in Hamilton, Ontario. Most amazing to him, he said, was that significantly fewer people developed diabetes in the rampipril group, suggesting this as a powerful new way to prevent the disease. This was the largest prevention trial ever involving diabetics, who made up about 40% of the group. A three-year follow-up study is planned.
"The beauty of this trial is that the results follow other proven therapies, like beta-blockers, statins, aspirin, calcium-channel blockers, or diuretics. I think all high-risk diabetics, such as those over 50-55 or who have eye disease or microalbuminuria, should take this drug," he said.
In addition to the good results with diabetes, the relative risk reduction for the ramipril group as a whole in coronary angioplasty, coronary artery bypass grafting, and peripheral angioplasty was 15%, compared with placebo. A three-year follow-up study is anticipated.
Other trials, involving about 6,000 patients, heralded a new approach to the treatment of cardiovascular disease. The first of a new drug class, the vasopeptidase inhibitor omapatrilat (Vanlev, Bristol-Myers Squibb) was shown to be superior to another antihypertensive now on the market-especially in reducing systolic hypertension, an important risk factor for stroke and death. The new drug, which inhibits the enzyme vasopeptidase, involves the simultaneous inhibition of neutral endopeptidase and angiotensin-converting enzyme. The resulting decrease in vascular tone lowers blood pressure. …