Impact of ramipril on the incidence of atrial fibrillation: Results of the Heart Outcomes Prevention Evaluation study

Salehian, Omid; Healey, Jeff; Stambler, Bruce; Alnemer, Khalid; Almerri, Khalid; Grover, John; Bata, Iqbal; Mann, Johannes; Matthew, James; Pogue, Janice; Yusuf, Salim; Dagenais, Gilles; Lonn, Eva; On Behalf of the HOPE Investigators,

doi:10.1016/j.ahj.2007.04.062

« Previous Next »American Heart Journal
Volume 154, Issue 3 , Pages 448-453, September 2007

Impact of ramipril on the incidence of atrial fibrillation: Results of the Heart Outcomes Prevention Evaluation study

Omid Salehian, MSc, MD, FACC
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Reprint requests: Omid Salehian, MSc, MD, FACC, McMaster University Medical Center, 1200 Main Street West, Room 3U8, Hamilton, Ontario, Canada L8N 3Z5.
Jeff Healey, MD
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Bruce Stambler, MD
- University Hospitals of Cleveland, Cleveland, OH
Khalid Alnemer, MD
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Khalid Almerri, MD
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
John Grover, MD
- St Vincent Hospital, Portland, OR
Iqbal Bata, MD
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
Johannes Mann, MD
- Schwabing Clinical Centre, Ludwig Maximilians University, Munich, Germany
James Matthew, MD
- University of Iowa College of Medicine, Iowa City, Iowa
- Wisconsin Cardiovascular Group, Milwaukee, WI
Janice Pogue, PhD
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
Salim Yusuf, MBBS, DPhil, FACC
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
Gilles Dagenais, MD, MSc, FACC
- Laval University Heart and Lung Institute, Quebec City, Quebec, Canada
Eva Lonn, MD, MSc, FACC
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
On Behalf of the HOPE Investigators

Received 27 February 2007; accepted 8 April 2007. published online 30 June 2007.

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.