ACE-Inhibitors Improve Outcomes in CAD

ACE-Inhibitors Improve Outcomes in CAD

By Jill Stein

DALLAS—Angiotensin-converting enzyme (ACE) inhibitors were shown to have favorable outcome in patients with coronary artery disease (CAD) while preserving left ventricular (LV) systolic function when added to standard therapy (ie, aspirin, beta-blockers, statins), according to findings from a meta-analysis reported at the American Heart Association’s Scientific Sessions 2005.

Mouaz Al-Mallah, MD, chief cardiology fellow, Henry Ford Hospital, Detroit, MI, presented the results of a review of data from multiple medical databases that included 17,000 patients with stable CAD and preserved LV systolic function who had been randomized to ACE inhibitor treatment and 16,959 patients who had been randomized to placebo. Participants were drawn from 7 randomized, placebo-controlled trials.

The analysis excluded trials that did not have a placebo arm or had a follow-up of <2 years as well as trials that did not report mortality, nonfatal myocardial infarction (MI) or revascularization.

“The evidence for routine administration of ACE inhibitors has been contradictory in patients with coronary artery disease with preserved LV systolic function,” Dr Al-Mallah observed. “While 2 large trials demonstrated a decrease in cardiovascular death and myocardial infarction, no such benefit was observed in another large trial and in a few smaller trials.”

Results of this meta-analysis indicated that ACE inhibitor treatment produced a 3.9 mm Hg mean decrease in systolic blood pressure (BP) and a 1.8 mm Hg mean decrease in diastolic BP.

Treatment with an ACE inhibitor was also associated with a reduction in cardiovascular mortality (RR = 0.83; P = .006), nonfatal MI (RR = 0.82; P = .001), all-cause mortality (relative risk [RR] = 0.87; P = .002), and revascularization (RR = 0.92; P = .04).

“Our results mean that treatment of 100 patients for an average duration of 4.4 years prevents either of the poor outcomes; that is 1 death or 1 nonfatal MI or 1 cardiovascular death or the need for 1 coronary revascularization procedure,” he said.

Dr Al-Mallah said that the trial results are bolstered by the fact that “it helps answer the general question of the beneficial effects of ACE inhibition in patients with coronary artery disease and preserved LV function with different treatment regimens.”

He noted that publication bias is a potential shortcoming of the trial. However, he was quick to add that the process of literature identification was comprehensive and performed by 2 investigators and an experienced librarian and should have captured the majority of published studies.