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Effects of an angiotensin-converting enzyme inhibitor (ramipril) on inflammatory markers in secondary prevention patients: RAICES Study

Lopez Santi, Ricardo G.a; Valeff, Eduardo C.a; Duymovich, Claudio R.a; Mazziotta, Danielb; Mijailovsky, Norma E.c; Filippa, Gerardo C.c; Maltez, Raúlc; Hernandez, Violeta A.a; Monroy, Alejandro Gomeza; Borzi, Jorge G.a; Acheme, Rosana A.a; Etchegoyen, María C.a; PROCORDIS investigators

Pathophysiology and Natural History

Aims: To evaluate the hypothesis that angiotensin-converting enzyme inhibitor therapy with ramipril reduces baseline levels of C-reactive protein in patients at high cardiovascular risk.

Methods: Secondary prevention patients were screened for eligibility and treated with ramipril for 6 month. Baseline and 6-month highly sensitive C-reactive protein levels were determined.

Results: A total of 77 patients were analyzed. The median highly sensitive C-reactive protein concentration at baseline was 2.17 mg/l (interquartile interval 0.97–4.54); whereas in post-treatment, the median was 1.70 mg/l (interquartile interval 0.88–3.41), P=0.0009. Patients were stratified according to risk level determined by baseline highly sensitive C-reactive protein levels: low-risk (<1 mg/l), intermediate risk (1–3 mg/l) and high risk (>3 mg/l) The reduction in highly sensitive C-reactive protein occurred at the expense of the high-risk group (baseline 5.02 mg/l, post-treatment 3.3 mg/l, P<0.0001), with no differences in the other groups. In multiple regression analysis, the reduction observed in the high-risk group could not be explained by baseline treatment or change in any of the variables analyzed.

Conclusion: Highly sensitive C-reactive protein levels were reduced after a 6-month ramipril therapy in secondary prevention patients, suggesting an anti-inflammatory effect of angiotensin-converting enzyme inhibitors. Future investigations will be done to confirm these results, and to investigate how angiotensin-converting enzyme inhibitor treatment elicits anti-inflammatory effects.

Secondary prevention patients were screened and treated with ramipril for 6 months. Baseline and 6-month highly sensitive C-reactive protein levels were determined. A total of 77 patients were analyzed. The median highly sensitive C-reactive protein concentration at baseline was 2.17 mg/l (0.97−4.54), whereas in post-treatment it was 1.70 mg/l (0.88−3.41), P =0.0009. Patients were stratified according to risk level determined by baseline highly sensitive C-reactive protein levels (American Heart Association and the Center for Disease Control). The reduction in highly sensitive C-reactive protein occurred at the expense of the high-risk group (baseline 5.02 mg/l, post-treatment 3.3 mg/l, P<0.0001), with no differences in the other groups. In multiple regression analysis, these observations could not be explained by baseline treatment or change in any of the variables analyzed. Highly sensitive C-reactive protein levels were reduced after a 6-month ramipril therapy in secondary prevention patients, suggesting an anti-inflammatory effect of angiotensin-converting enzyme inhibitors.

aPROCORDIS, Fundación Bioquímica Argentina, La Plata

bLARESBIC, Fundación Bioquímica Argentina, La Plata

cFederación Argentina de Cardiología, Río Grande, Argentina

Sponsorships: Fundación Bioquímica Argentina, unrestricted grant provided by Aventis Pharma.

Conflict of interest: No conflicts of interest to declare.

Correspondence and requests for reprints to: Ricardo G. Lopez Santi, M.D., Procordis Director, FBA, La Plata, Argentina. Personal address: 19 No. 2656, e/505 y 506 (Zip code 1897) La Plata, Argentina

e-mail: procordis@fba.org.ar

Received 5 May 2004 Accepted 6 May 2005

© 2005 Lippincott Williams & Wilkins, Inc.