Heart Drug Slows Plaque Buildup

A new study has shown that an angiotensin-converting enzyme (ACE) inhibitor called ramipril, used to reduce the risk of heart attacks and strokes, can also slow the progression of atherosclerosis. The study, published in the February 19 issue of Circulation, was called SECURE (study to evaluate carotid ultrasound changes in patients treated with Ramipril and vitamin E).

The study involved 732 patients age 55 or older who had vascular disease or diabetes and at least one other cardiovascular risk factor and who did not have heart failure or a low left ventricular ejection fraction. Patients were randomly assigned to receive either ramipril 2.5 mg a day or 10 mg a day or vitamin E 400 IU/d or their matching placebos. Atherosclerosis progression was measured by a special ultrasound measure of the thickness of the wall of the carotid arteries.

The results showed that the carotid arterial wall was reduced by about one third in patients treated with ramipril 10 mg/day in addition to other medications (aspirin, lipid-lowering agents, beta blockers, and calcium-channel blockers), compared to patients receiving placebo. No differences were found in atherosclerosis progression rates between patients on vitamin E and those on placebo. The study was conducted by researchers from McMaster University (Hamilton, Canada). Previous studies with ACE inhibitors failed to demonstrate an impact on atherosclerosis progression. The researchers speculate that the difference between those and the current results may be related to the specific ACE inhibitor used, the dosage, the study design, or the measurement methods used to evaluate the progression.

"This study demonstrates that by using ramipril on top of statins and other therapies, we can enhance the benefits of statins and even further slow the progression of atherosclerosis,” said Dr. Eva Lonn, associate professor of medicine at McMaster University, and the lead investigator of the study.



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