Ace Inhibitors May Reduce Death, Heart Attack

Angiotension-converting enzyme (ACE) inhibitors, medications usually used to treat high blood pressure (high blood pressure), may reduce cardiovascular risk and the risk of death in patients with coronary artery disease, as per a new analysis of previously conducted clinical trials published in the April 10 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Several medications are available to treat patients with coronary artery disease, characterized by blockages in the vessels that supply blood to the heart, as per background information in the article. Scientists continue to examine the effectiveness of each medicine in different patient groups. Prior research has shown that ACE inhibitors can help treat patients with coronary artery disease or congestive heart failure, which occurs when the heart loses its ability to pump blood efficiently, if that patient also has problems with the left ventricle, the lower left chamber of the heart. However, studies on the use of ACE inhibitors in patients with coronary artery disease but without heart failure or left ventricle dysfunction have had conflicting results.

Nicolas Danchin, M.D., F.E.S.C., Hôpital Europeen Georges Pompidou, Paris, and his colleagues analyzed seven prior randomized and controlled trials of ACE inhibitors in patients with coronary artery disease. The studies tested five different ACE inhibitors and included a total of 33,960 patients, who were followed for a minimum of two years and an average of 4.4 years. In each trial, some patients were randomly selected to receive ACE inhibitors and others to receive placebos.

When the results of all the trials were analyzed together, therapy with ACE inhibitors significantly reduced the risk of death from any cause, cardiovascular death, myocardial infarction (heart attack) and stroke. The scientists also found that in studies that measured additional outcomes, ACE inhibitors appeared to reduce the risk of onset of diabetes, hospitalization for congestive heart failure and cardiac arrest.

"In this overview of randomized trials of ACE inhibitors for the long-term secondary prevention of coronary artery disease in patients without left ventricular dysfunction or heart failure, active therapy was associated with a highly significant reduction in all-cause mortality and all major cardiovascular events," the authors conclude. "These results, along with those previously reported in patients who have coronary artery disease with left ventricular dysfunction or heart failure, suggest that ACE inhibitor treatment should be systematically used in all patients with documented coronary artery disease."



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