Prevention

Give an ACE inhibitor ^a

Why?

• Patients at high-risk for cardiovascular disease who take ramipril are less likely to die, have a stroke, myocardial infarction, cardiac arrest or develop heart failure. ^a
• Many patients stop therapy, particularly due to cough. ^a

Ramipril reduces death and cardiovascular complications in patients at high-risk for cardiovascular disease

Patient a	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
previous stroke, MI or peripheral vascular disease and at least one other cardiovascular risk factor	ramipril	placebo	death from any cause at 5 years	12%	15% (5% to 24%)	55 (32 to 180)
			myocardial infarction at 5 years	12%	19% (9% to 28%)	44 (28 to 99)
			stroke at 5 years	4.9%	30% (15% to 43%)	68 (44 to 150)
			heart failure at 5 years	12%	22% (12% to 31%)	39 (26 to 77)
			cardiac arrest at 5 years	1.3%	36% (4% to 58%)	220 (120 to 2400)
			discontinued therapy permanently at 5 years	31%	-6% (-13% to -0.086%)	-52 (-3500 to -26)
			treatment discontinued due to cough at 5 years	1.9%	-300% (-410% to -220%)	-18 (-22 to -16)