NEW YORK, Mar 22 (Reuters Health) - The blood pressure-lowering drug ramipril can protect against stroke in high-risk individuals even if their blood pressure is normal, an international research team reports.

The findings suggest that ACE inhibitors, the drug class to which ramipril belongs, should be considered for any patient at high risk of cardiovascular disease, the study's lead author told Reuters Health.

"The results of this and other studies indicate that the effect of ACE inhibitors goes beyond the known blood pressure explanation," said Dr. Jackie Bosch of McMaster University in Hamilton, Ontario, Canada.

She and her colleagues report their results in the March 23rd issue of the British Medical Journal.

Their findings come from a large international trial known as the HOPE study, which had previously shown that ramipril can cut the risk of heart attack, stroke and other complications among people with significant risk factors.

The study compared the effects of ramipril, vitamin E, the drug and vitamin together, and inactive treatment with a placebo. Nearly 9,300 patients with stroke risk factors such as heart or blood vessel disease were followed for an average of 4.5 years.

Overall, ramipril cut the risk of stroke by one-third and the risk of fatal stroke by 61%, Bosch's team reports. The benefits occurred despite only modest dips in patients' blood pressure and were seen in patients with relatively normal blood pressure to begin with, the report indicates.

In addition, stroke risk fell in patients who were on cholesterol-lowering drugs or antiplatelet therapy, in which drugs such as aspirin are used to prevent blood clotting.

According to the researchers, these findings, along with past research, suggest that wider use of ACE inhibitors in patients with high stroke risk could have a "major impact on public health."

In the US, ramipril is marketed as Altace by King Pharmaceutical. The drug company Aventis markets it as Tritace and Delix in Europe. Both companies provided some funding for the study.

ACE inhibitors lower blood pressure by blocking an enzyme that helps constrict blood vessels. Bosch said it is not fully clear how the drugs ward off cardiovascular complications independent of their effects on blood pressure.

However, she noted, researchers speculate that ACE inhibitors may prevent artery-clogging plaques from progressing or from rupturing, which can then trigger a heart attack or stroke.

(British Medical Journal 2002; 324:699-702.)

Source: www.laurushealth.com

2) A drink a day may cut stroke risk for some: study

NEW YORK, Apr 19 (Reuters Health) - Men and women in their 60s who consume one to two drinks a day appear to have a lower risk of stroke compared with their peers who consume less alcohol, study findings suggest.

Curiously, the same stroke-reducing benefits were not seen in other age groups, according to the report published in the April issue of Stroke: Journal of the American Heart Association.

However, too much alcohol has been shown to increase the risk of stroke, the authors note. Past studies have found that binge drinking raises blood pressure and possibly stroke risk, and other research has suggested that the risk of stroke increases with heavy alcohol intake.

In the new study, a reduced risk of stroke was found in men and women aged 60 to 69 who consumed 12 to 23 grams of alcohol per day, with one drink being equivalent to 12 grams of alcohol, reports Dr. Luc Djousse of Boston University School of Medicine in Massachusetts.

Over a 30-year period, Djousse's team evaluated the alcohol consumption habits of 5,209 men and women participating in the Framingham Study, the ongoing analysis of residents of Framingham, Massachusetts.

During that time, 196 men and 245 women had an ischemic stroke, the most common type of stroke, which is caused by a blockage in an artery supplying blood to the brain.

While total alcohol consumption was not associated with ischemic stroke across all age groups, the researchers report that a protective effect was observed among men and women in their 60s who had a history of moderate alcohol intake over the course of the study.

When the investigators looked at what type of alcohol the study participants consumed, only wine seemed to lower stroke risk, not beer or alcohol.

"We do not have a biological explanation for these findings and can only speculate," Djousse and colleagues write.

Other studies have found that moderate consumption of any type of alcohol--be it beer, wine or spirits--can lower heart disease risk, most likely due to the blood-thinning effects of alcohol.

Nonetheless, the authors note that wine, in addition to the alcohol, contains phenolic compounds that have antioxidant properties. Together these substances may act to reduce the build-up of fatty plaques in a person's arteries, which can lead to the heart disease atherosclerosis.

Source: www.reutershealth.com