Question

Extract the following information from the abstract:

Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients.

Abstract

BACKGROUND: We assessed the role of an angiotensin-converting-enzyme inhibitor, ramipril, in patients who were at high risk for cardiovascular events.

METHODS: A total of 9297 high-risk patients (55 years of age or older) who had evidence of vascular disease or diabetes plus one other cardiovascular risk factor were randomly assigned to receive ramipril (10 mg once per day orally) or matching placebo for a mean of five years. The primary outcome was a composite of myocardial infarction, stroke, or death from cardiovascular causes.

RESULTS: A total of 651 patients who were assigned to receive ramipril (14.0 percent) reached the primary end point, as compared with 826 patients who were assigned to receive placebo (17.8 percent) (relative risk, 0.78; 95 percent confidence interval, 0.70 to 0.86; P<0.001).

Treatment with ramipril reduced the risks of death from cardiovascular causes (6.1 percent, as compared with 8.1 percent in the placebo group; relative risk, 0.74; P<0.001), myocardial infarction (9.9 percent vs. 12.3 percent; relative risk, 0.80; P<0.001), stroke (3.4 percent vs. 4.9 percent; relative risk, 0.68; P<0.001), death from any cause (10.4 percent vs. 12.2 percent; relative risk, 0.84; P=0.005), revascularization procedures (16.3 percent vs. 18.8 percent; relative risk, 0.85; P<0.001), cardiac arrest (0.8 percent vs. 1.3 percent; relative risk, 0.62; P=0.02), [corrected] heart failure (9.1 percent vs. 11.6 percent; relative risk, 0.77; P<0.001), and complications related to diabetes (6.4 percent vs. 7.6 percent; relative risk, 0.84; P=0.03).

CONCLUSIONS: Ramipril significantly reduces the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients.

3. Which of the numbers present an information about relative effect measure for the association between the main exposure and the primary outcome.

Question 3 options:

	a) 17.8
	b) 14.0
	c) 0.78

Question 4 (6 points)

4. Which calculation correctly depicts absolute effect measure for the association between the main exposure and myocardial infarction?

Question 4 options:

	a) 9.9-12.3
	b) 12.3-9.9
	c) 17.7-14.0
	d) 0.74-0.8

What is the main exposure?

The primary outcome is

Question 2 options:

	a) Ramipril 10 mg once per day
	b) Diabetes
	c) Any cardiovascular disease risk factor
	d) Angiotensin-converting-enzyme inhibitor

Answer 1

2. EFFECTS OF RAMIPRIL ON CARDIOVASCULAR EVENTS IN HIGH RISK PATIENTS IS

c) any cardiovascular disease risk factor.

3. b) 14.0

4. a) 9.9 -12.3

MAIN EXPOSURE - Total of 1477(651+826) patients

Primary outcome-- Primary outcome after 5 years is composite of MI,stroke or death from cardiovascular causes.