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(Stroke. 2003;34:e208.)
© 2003 American Heart Association, Inc.

Letters to the Editor

Angiotensin-Converting Enzyme Inhibitors and Stroke Prevention: What About the Influence of Atrial Fibrillation and Antithrombotic Therapy?

Second Medical Department, Krankenanstalt Rudolfstiftung, Wien, Austria

Michael Brainin, MD

Neurosciences Centre, Donau-Universität,, Department of Neurology, Donauklinikum, Maria Gugging, Austria

Josef Finsterer, MD

Neurologic Department, Krankenanstalt Rudolfstiftung, Wien, Austria

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor

The Heart Outcomes Prevention Evaluation (HOPE) trial and Losartan Intervention For Endpoint Reduction in Hypertension Study (LIFE) have shown that ramipril and losartan lower the risk of ischemic vascular events, including strokes.^1–3 This effect, which is independent of lowering blood pressure, is explained by pharmacological mechanisms, which are further consequences of inhibition of the renin-angiotensin system in the plasma and vascular wall. These potential mechanisms comprise reduction in proliferation of vascular smooth muscle cells, enhancement of endogenous fibrinolysis, stabilization of plaques, decrease in angiotensin II–mediated atherosclerosis, plaque rupture, and vascular occlusion.⁴ Atherosclerosis, however, is not the only cause of stroke. Stroke may also be due to embolism, vasculitis, or coagulation abnormalities. Stroke may be due to cardiogenic embolism, most frequently in atrial fibrillation. Atrial fibrillation is an independent risk factor for stroke, and 16% of ischemic strokes are associated with atrial fibrillation.⁵

Although the participants in the HOPE study had a 12-lead ECG at baseline, at 2 years, and at study end and some ECG findings have been reported, the prevalence of atrial fibrillation has not been mentioned.^1,2,6 It can be expected that the prevalence of atrial fibrillation in the patients of the HOPE study is high, because the same risk factors, which were inclusion criteria for the HOPE study, have been identified by epidemiological studies to also be risk factors for the development of atrial fibrillation: increased age, hypertension, coronary heart disease, elevated serum cholesterol levels, and smoking.⁷ Uninformed about the prevalence of atrial fibrillation and . . . [Full Text of this Article]