Equivalent results were seen in HOPE and EUROPA when examined by age, sex, known IHD, LV function, previous MI, hypertension, or diabetes mellitus. In QUIET (Quinapril Ischemic Event Trial), there was also no sig- nificant reduction with quinapril in ischemic events and progression of CAD in coronary angioplasty patients without systolic LV dysfunction (RR: 13%; P0.49), although this finding has been attributed to study design limitations.797 Similarly, the IMAGINE (Ischemia Man- agement With Accupril Post-Bypass Graft via Inhibition of the Converting Enzyme) study demonstrated no reduction in clinical outcomes in low-risk patients (LVEF with quinapril after surgical revascularization.803 In a meta-analysis of ACE-inhibitor therapy versus placebo in 31 555 patients from HOPE, EUROPA, PEACE, and QUIET, ACE-inhibitor therapy produced 14% reductions in all-cause mortality and MI (both P0.0004), a 23% reduction in stroke (P0.0004), and a 7% reduction in revascularization procedures (P0.025) compared with Although the cited studies involved a variety of ACE inhibitors that differ with regard to structure, bioavailability, potency, receptor-binding characteristics, tissue distribution, metabolism, and excretion properties, there is little evidence that these differences are associated with therapeutic advan- tages. Because the benefits of ACE inhibitors seem to reflect a class effect, the selection of a particular agent can be based on such factors as availability in local formularies, cost, and tolerability. ACE inhibitors are recommended for all patients with SIHD and hypertension, diabetes mellitus, LV dysfunction (EF 40%), or CKD. Also included in the HOPE301 or EUROPA296 trials were participants who did not have one of these conditions but did have multiple cardiac risk factors, and it seems that they also benefited from use of ACE ARBs also play an important role in vascular protection. 