ACE inhibitors may reduce death, heart attack and stroke in patients with coronary artery disease

Angiotension-converting enzyme (ACE) inhibitors, medications commonly used to treat hypertension (high blood pressure), may reduce cardiovascular risk and the risk of death in patients with coronary artery disease, according to a new analysis of previously conducted clinical trials reported 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, according to background information in the article. Researchers continue to examine the effectiveness of each medication in different patient groups. Previous 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 Européen Georges Pompidou, Paris, and colleagues analyzed seven previous 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, treatment with ACE inhibitors significantly reduced the risk of death from any cause, cardiovascular death, myocardial infarction (heart attack) and stroke. The researchers 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 treatment 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 therapy should be systematically used in all patients with documented coronary artery disease."

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(Arch Intern Med. 2006; 166: 787-796. Available pre-embargo to media at www.jamamedia.org.)

Editor's Note: Please see study for financial disclosures from authors.


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