Drugs currently used to treat heart failure should be considered for all patients with hardening of the arteries (atherosclerosis), according to an Article in this week's issue of The Lancet. The study suggests that ACE (angiotensin-converting enzyme) inhibitors may reduce the number of serious circulatory problems, such as heart attack and stroke, in patients with atherosclerosis.
Doctors already know that ACE inhibitors reduce mortality and heart attack in patients with heart failure. In addition, three large trials have assessed the effect of ACE inhibitors in patients who have not had heart failure but have atherosclerosis. Gilles Dagenais (The Laval University Heart and Lung Institute, Laval Hospital, Quebec, Canada) and colleagues combined the data from these three studies involving over 29 800 patients. The participants had been randomly assigned an ACE inhibitor or placebo for an average of 4.5 years. They found that ACE inhibitors reduced the risk of a range of outcomes including all-cause mortality (8.9 vs 7.8%), non-fatal heart attack (6.4 vs 5.3%), stroke (2.8 vs 2.2%), and heart failure (2.7 vs 2.1%) when compared with placebo. When the researchers compared these results to that of five trials where ACE inhibitors were used to treat heart failure, they found the reduction in risk for death, heart attack, and heart failure was similar. The authors conclude that ACE inhibitors are beneficial for patients with atherosclerosis, as well as for those with heart failure.
Dr Dagenais comments: "...the use of ACE inhibitors should be considered in all patients with vascular disease as long as they can tolerate these agents and the absolute benefits are judged to be valuable."
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However, in an accompanying Comment Giuseppe Remuzzi and Piero Ruggenenti from the Mario Negri Institute for Pharmacological research in Bergamo, Italy disagree with the authors conclusions. They state that a closer examination of the data shows that ACE inhibitors were only beneficial in two of the three trials studied. One of the trials found that ACE inhibitors were no better than placebo.
Contact: Gilles Dagenais, The Laval University Heart and Lung Institute, Laval Hospital, Quebec, Canada. T) (418) 656-4560 and firstname.lastname@example.org