Effects of Ramipril and Vitamin E on Atherosclerosis: The Study to Evaluate Carotid Ultrasound Changes in Patients Treated With Ramipril and Vitamin E (SECURE)
Abstract
Background —Activation of the renin-angiotensin-aldosterone system and oxidative modification of LDL cholesterol play important roles in atherosclerosis. The Study to Evaluate Carotid Ultrasound changes in patients treated with Ramipril and vitamin E (SECURE), a substudy of the Heart Outcomes Prevention Evaluation (HOPE) trial, was a prospective, double-blind, 3×2 factorial design trial that evaluated the effects of long-term treatment with the angiotensin-converting enzyme inhibitor ramipril and vitamin E on atherosclerosis progression in high-risk patients. Methods and Results —A total of 732 patients ≥55 years 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 ejection fraction were randomly assigned to receive ramipril 2.5 mg/d or 10 mg/d and vitamin E (RRR-α-tocopheryl acetate) 400 IU/d or their matching placebos. Average follow-up was 4.5 years. Atherosclerosis progression was evaluated by B-mode carotid ultrasound. The progression slope of the mean maximum carotid intimal medial thickness was 0.0217 mm/year in the placebo group, 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 atherosclerosis progression rates between patients on vitamin E and those on placebo. Conclusions —Long-term treatment with ramipril had a beneficial effect on atherosclerosis progression. Vitamin E had a neutral effect on atherosclerosis progression.
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Vitamin E did not prevent the progression of carotid intima-media thickness in high-risk patients with diabetes.
“Vitamin E also did not prevent the progression of carotid intima-media thickness in high-risk patients with diabetes (202).”
From Mitochondrial Dysfunction in Diabetes: From Molecular Mechanisms to Functional Significance and Therapeutic Opportunities (2010) · cites this paper as [202]
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- Lonn EM, Yusuf S, Doris CI, et al. Study design and baseline character- istics of the Study to Evaluate carotid Ultrasound changes in patients treated with Ramipril and vitamin E (SECURE). Am J Cardiol. 1996;78: 914 -919.
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- Authors
- Lonn, E. M., Yusuf, S., Dzavik, V., Doris, C. I., Yi, Q., Smith, S., Moore-Cox, A., Bosch, J., Riley, W. A., & Teo, K. K.
- Affiliations
- Atrium Health Wake Forest Baptist (US)
- From the Departments of Medicine (E.M.L., S.Y., Q.Y., S.S., A.M.-C., J.B., K.K.T.) and Radiology (C.I.D.), McMaster University, Hamilton, Ontario, Canada; The University of Alberta Hospitals, Edmonton, Alberta, Canada (V.D., K.K.T.); the Canadian Cardiovascular Collaboration (E.M.L., S.Y., V.D., C.I.D., Q.Y., S.S., A.M.-C., J.B., K.K.T.); and the Bowman Gray School of Medicine, Department of Neurology, Winston-Salem, NC (W.A.R.).
- Venue
- Circulation
- Published
- 2001-02-20
- Volume
- 103
- Issue
- 7
- Pages
- 919-925
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2034914625
- Cited by
- 712
- References
- 30
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 5 · 2023: 5 · 2022: 3 · 2021: 16 · 2020: 8 · 2019: 9 · 2018: 7 · 2017: 9 · 2016: 10 · 2015: 10 · 2014: 19 · 2013: 15 · 2012: 20
- FWCI
- 64.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medical Research Council Canada
- Medical Research Council
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Keywords
- ramipril, vitamin E, atherosclerosis progression, carotid intima-media thickness, ACE inhibitors, renin-angiotensin-aldosterone system, high-risk patients, vascular disease, diabetes mellitus
- MeSH terms
- Aged, Analysis of Variance, Angiotensin-Converting Enzyme Inhibitors, Arteriosclerosis, Blood Pressure, Carotid Artery Diseases, Creatinine, Double-Blind Method, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Compliance, Potassium, Prospective Studies, Risk Factors, Ultrasonography, Vitamin E, Treatment Outcome, Ramipril, Disease Progression
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