Age-related short-term effect of ramipril on N-terminal pro-brain natriuretic peptide and markers of hemostasis in patients after acute myocardial infarction
BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors after acute myocardial infarction (MI) prevent heart failure and recurrent ischemic events. Our aim was to evaluate the effect of ramipril on N-terminal pro-brain natriuretic peptide (NT-proBNP) and on markers of hemostasis, including plasminogen-activator-inhibitor-1 (PAI-1), von Willebrand factor (vWF), factor VIII (FVIII) and fibrinogen, in patients after acute MI, with emphasis on those over 55 years of age.
METHODS: In this prospective, single-center, observational study 38 patients were treated with ramipril after the first Q-wave MI. Markers of hemostasis and NT-proBNP were estimated before and two weeks after ramipril treatment.
RESULTS: Significant differences were observed in PAI-1 and NT-proBNP levels in patients over 55 years. In this age group the mean PAI-1 level decreased significantly after ramipril therapy (3.6 ± 1.25 U/ml vs. 2.65 ± 1.4 U/ml, P = 0.011) and was significantly lower than in younger (<55 years) patients (2.65 ± 1.4 U/ml vs. 4.39 ± 1.7 U/ml, P = 0.002). In addition, in the older patients the mean baseline NT-proBNP level was significantly higher than in the younger age group (258.35 ± 347.6 pmol/l vs. 17.1 ± 22 pmol/l, P = 0.028) and was also higher after ramipril therapy (240.5 ± 254.3 pmol/l vs. 67.3 ± 75.2 pmol/l, P = 0.034). In the younger patients, mean NT-proBNP after short-term ramipril therapy increased significantly in comparison with baseline (67.3 ± 75.2 pmol/l vs. 17.15 ± 22.0 pmol/l, P = 0.046).
CONCLUSION: In acute Q-wave MI, increased PAI-1 levels, but not increased NT-proBNP, respond rapidly to early ACE inhibition by ramipril in patients over 55 years of age but not in younger patients.