Die Heart Outcomes Prevention Study (HOPE) ist eine der größten Untersuchungen, die neue Interventionsmöglichkeiten für die Prävention kardiovaskulärer Ereignisse überprüft. Teilgenommen haben 9.297 Hochrisikopatienten, d.h. Menschen in einem Alter von wenigstens 55 Jahren, bei denen Diabetes mellitus oder eine vaskuläre Erkrankung sowie ein weiterer kardiovaskulärer Risikofaktor nachzuweisen war. Die Studienteilnehmer erhielten randomisiert entweder den ACE-Hemmer Ramipril (einmal täglich 10 mg oral) oder Placebo. Primäre Studienendpunkte waren Myokardinfarkt, Schlaganfall oder Tod aufgrund eines kardiovaskulären Ereignisses. Die Studie wurde aufgrund der deutlichen Überlegenheit von Ramipril nach 4,5 Jahren vorzeitig abgebrochen. Die Präsentation der Ergebnisse erfolgte im Oktober 1999 auf dem XXIst Congress of the European Society of Cardiology in Barcelona, Spanien. Publiziert wurden sie im Januar 2000 im New England Journal of Medicine.

Wichtigste Ergebnisse

• Reduktion des relativen Risikos für schwere kardiovaskuläre Ereignisse um 22% (p<0,000002)
• Reduktion der Gesamtsterblichkeit bei Diabetikern um 24%
• Überlebensvorteil in allen Subgruppen
• Reduktion des Sterberisikos stieg mit Dauer der Behandlung
• Verbesserung der Prognose von Diabetes mellitus (kein vordefinierter Endpunkt, muss daher überprüft werden)
• Reduktion der Inzidenz mikroangiopathischer Ereignisse bei Diabetikern (MICRO HOPE)
• die HOPE-Studie erweitert den Kreis der Patienten, die von ACE-Hemmern profitierten, um den Faktor 15 oder 20

Hauptpublikationen der HOPE-Studie

Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000 Jan 20;342(3):145-53.

Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000 Jan 20;342(3):154-60.

Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet 2000 Jan 22;355(9200):253-9.

The use of targeting criteria in hospitalized HMO patients: results from the demonstration phase of the Hospitalized Older Persons Evaluation (HOPE) Study. J Am Geriatr Soc 1992 May;40(5):482-8.
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The HOPE (Heart Outcomes Prevention Evaluation) Study: the design of a large, simple randomized trial of an angiotensin-converting enzyme inhibitor (ramipril) and vitamin E in patients at high risk of cardiovascular events. The HOPE study investigators. Can J Cardiol 1996 Feb;12(2):127-37.
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Rationale and design of a large study to evaluate the renal and cardiovascular effects of an ACE inhibitor and vitamin E in high-risk patients with diabetes. The MICRO-HOPE Study. Microalbuminuria, cardiovascular, and renal outcomes. Heart Outcomes Prevention Evaluation. Diabetes Care 1996 Nov;19(11):1225-8.
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Prevalence and determinants of microalbuminuria in high-risk diabetic and nondiabetic patients in the Heart Outcomes Prevention Evaluation Study. The HOPE Study Investigators. Diabetes Care 2000 Apr;23 Suppl 2:B35-9.
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Should the results of the HOPE study affect nephrological practice? For the HOPE investigators. Nephrol Dial Transplant. 2000 Apr;15(4):453-4. Review. No abstract available.
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The HOPE study. Ramipril lowered cardiovascular risk, but vitamin E did not. Cleve Clin J Med. 2000 Apr;67(4):287-93.
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The HOPE study and diabetes. Heart Outcomes Prevention Evaluation. Lancet. 2000 Apr 1;355(9210):1181; discussion 1183-4. No abstract available.
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The HOPE study and diabetes. Heart Outcomes Prevention Evaluation. Lancet. 2000 Apr 1;355(9210):1182; discussion 1183-4. No abstract available.
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The HOPE study and diabetes. Heart Outcomes Prevention Evaluation. Lancet. 2000 Apr 1;355(9210):1183; discussion 1183-4. No abstract available.
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The HOPE study. Cleve Clin J Med. 2000 Jun;67(6):452. No abstract available.
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HOPE and elderly patients attending geriatric day hospital. Heart Outcomes Prevention Evaluation Study. Lancet. 2000 Aug 5;356(9228):511-2. No abstract available.
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HOPE for all people with diabetes? Heart Outcomes Prevention Evaluation. Diabet Med. 2000 Sep;17 Suppl 2:9-10. No abstract available.
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After the HOPE Study. ACE inhibitor now for every diabetic patient?. Interview by Dr. Dirk Einecke. MMW Fortschr Med. 2000 Nov 2;142(44):10. German. No abstract available.
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(s. auch: Deutsche Artikel / Herz/Niere; passwortgeschützt)

Angiotensin-converting enzyme (ACE) inhibition in the secondary prevention of vascular disease: the Heart Outcomes Prevention Evaluation (HOPE) Trial and its substudies. Curr Atheroscler Rep. 2000 Sep;2(5):361-2. No abstract available.
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The HOPE Study. What does it contribute to general practice? MMW Fortschr Med. 2000 Nov 23;142(47):28-32. German.
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(s. auch: Deutsche Artikel / Herz/Niere; passwortgeschützt)

Clinical, public health, and research implications of the Heart Outcomes Prevention Evaluation (HOPE) Study. Eur Heart J. 2001 Jan;22(2):103-4. No abstract available.
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The Heart Outcomes Prevention Evaluation Study. Curr Cardiol Rep. 2001 Mar;3(2):106-7. No abstract available.
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Implications from the Heart Outcomes Prevention Evaluation. Curr Opin Nephrol Hypertens. 2001 Jan;10(1):61-3. Review. No abstract available.
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Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med. 2001 Apr 17;134(8):629-36.
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Why were the results of the Heart Outcomes Prevention Evaluation (HOPE) trial so astounding? Can J Cardiol. 2001 May;17 Suppl A:15A-7A.
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Clinical Trials: The HOPE Trial. Am J Geriatr Cardiol. 2000 May;9(3):172-173. No abstract available.
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The HOPE study: comparison with other trials of secondary prevention. Eur Heart J. 2001 Aug;22(15):1307-10. No abstract available.
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Effects of ramipril on coronary events in high-risk persons: results of the Heart Outcomes Prevention Evaluation Study. Circulation. 2001 Jul 31;104(5):522-6.
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The Heart Outcomes Prevention Evaluation study: angiotensin-converting enzyme inhibitors: are their benefits a class effect or do individual agents differ? Curr Opin Nephrol Hypertens. 2001 Sep;10(5):597-601.

Renal insufficiency predicts cardiovascular disease in high-risk individuals: the benefit of ramipril in the HOPE study. Heart Outcomes and Prevention Evaluation. J Clin Hypertens (Greenwich). 2001 Jul-Aug;3(4):256-7. No abstract available.
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HOPE for patients with Type 2 diabetes: an application of the findings of the MICRO-HOPE substudy in a British hospital diabetes clinic. Diabet Med. 2001 Aug;18(8):667-70.
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What is the relevance of the HOPE study in general practice? Int J Clin Pract. 2001 Sep;55(7):449-57. Review.
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Pharmacoeconomic impact of HOPE. Int J Clin Pract Suppl. 2001 Jan;(117):19-21.
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Diabetes and the HOPE study: implications for macrovascular and microvascular disease. Int J Clin Pract Suppl. 2001 Jan;(117):8-12.
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An ACE inhibitor to coronary patients: ramipril reduces mortality according to HOPE trial. Prescrire Int. 2001 Apr;10(52):62-3. No abstract available.
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