Coronary artery disease - Impact of ramipril on the incidence of atrial fibrillation: Results of the Heart Outcomes Prevention Evaluation study

被引:70
作者
Salehian, Omid
Healey, Jeff
Slambler, Bruce
Alnemer, Khalid
Almerri, Khalid
Grover, John
Bata, Iqbal
Mann, Johannes
Matthew, James
Pogue, Janice
Yusuf, Salim
Dagenais, Gilles
Lonn, Eva
机构
[1] McMaster Univ, Dept Med, Div Cardiol, Hamilton, ON L8S 4L8, Canada
[2] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON L8S 4L8, Canada
[3] Univ Hosp Cleveland, Cleveland, OH 44106 USA
[4] St Vincent Hosp, Portland, OR USA
[5] Dalhousie Univ, Dept Med, Halifax, NS, Canada
[6] Univ Munich, Schwabing Clin Ctr, Munich, Germany
[7] Univ Iowa, Coll Med, Iowa City, IA 52242 USA
[8] Wisconsin Cardiovasc Grp, Milwaukee, WI USA
[9] Univ Laval, Heart & Lung Inst, Quebec City, PQ G1K 7P4, Canada
关键词
D O I
10.1016/j.ahj.2007.04.062
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives We evaluated the effect of angiotensin-converting enzyme (ACE) inhibitor ramipril on the incidence of atrial fibrillation (AF) in patients enrolled in the Heart Outcomes Prevention Evaluation trial. Background Atrial fibrillation is the most common arrhythmia affecting the general population and is associated with increased morbidity and mortality. Retrospective secondary analyses of some of the large trials of ACE inhibitors have suggested that ACE inhibitors' may prevent AF. Methods We evaluated the occurrence of AF by reviewing the electrocardiogram tracings at entry, at 2 years, and at the end of the study, as well as hospitalizations among 8335 high-risk participants from the Heart Outcomes Prevention Evaluation study, >= 55 years, without known heart failure or left ventricular (LV) systolic dysfunction and followed for a median period of 4.5 years. We compared the impact of ramipril and matched placebo on occurrence of AF. The results were compared to similar trials. Results Over the 4.5 years follow-up, the incidence of new AF was low (2.1%, 177/8335), and ramipril did not significantly reduce the rate of new AF compared with placebo (86/4291 [2.0%] vs 91/4044 [2.2%]) with an odds ratio of 0.92 (95% confidence interval, 0.68-1.24; P = .57). These results added to the previous ACE inhibitor trials (excluding trials in patients with LV dysfunction) showed no significant reduction in new AF among patients treated with these agents (1088/20,930 [5.0%] vs 1343/22,878 [5.9%]; relative risk, 0.92; 95% confidence interval, 0.80-1.05). Conclusion Although the incidence of AF was low, treatment with ramipril in this population without known LV systolic dysfunction did not significantly reduce this dysrrhythmia.
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收藏
页码:448 / 453
页数:6
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