There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
Abstract
The cardiovascular risk associated with early renal insufficiency is unknown. Clinicians
are often reluctant to use angiotensin-converting enzyme inhibitors in patients with
renal insufficiency.
To determine whether mild renal insufficiency increases cardiovascular risk and whether
ramipril decreases that risk.
Post hoc analysis.
The Heart Outcomes and Prevention Evaluation (HOPE) study, a randomized, double-blind,
multinational trial involving 267 study centers.
980 patients with mild renal insufficiency (serum creatinine concentration >/= 124
micromol/L [>/=1.4 mg/dL]) and 8307 patients with normal renal function (serum creatinine
concentration < 124 micromol/L [<1.4 mg/dL]) Patients with a baseline serum creatinine
concentration greater than 200 micromol/L (2.3 mg/dL) were excluded.
The primary outcome measure was incidence of cardiovascular death, myocardial infarction,
or stroke.
Cumulative incidence of the primary outcome was higher in patients with renal insufficiency
than in those without (22.2% vs. 15.1%; P < 0.001) and increased with serum creatinine
concentration. Patients with renal insufficiency had a substantially increased risk
for cardiovascular death (11.4% vs. 6.6%) and total mortality (17.8% vs. 10.6%) (P
< 0.001 for both comparisons). The effect of renal insufficiency on the primary outcome
(adjusted hazard ratio, 1.40 [95% CI, 1.16 to 1.69]) was independent of known cardiovascular
risks and treatment. Ramipril reduced the incidence of the primary outcome in patients
with and those without renal insufficiency (hazard ratio, 0.80 vs. 0.79; P > 0.2 for
the difference).
In patients who had preexisting vascular disease or diabetes combined with an additional
cardiovascular risk factor, mild renal insufficiency significantly increased the risk
for subsequent cardiovascular events. Ramipril reduced cardiovascular risk without
increasing adverse effects.
[1
]From McMaster University, Hamilton, Ontario, Canada; Schwabing General Hospital, Ludwig
Maximilians University, Munchen, Germany; and the German Institute for High Blood
Pressure Research, Heidelberg, Germany.