For People With Heart Disease, ACE Inhibitors Reduce Risk of Heart Attack, Stroke, and Death
The leading cause of death for both men and women in the US is ]]>coronary artery disease (CAD)]]> . CAD is a form of heart disease due to plaque buildup and narrowing of the blood vessels that carry oxygen to the heart. A lack of oxygen in the heart can lead to ]]>angina]]> , ]]>heart attack]]> , or death. One class of drugs used to treat CAD is angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril, captopril, and ramipril. Previous research has shown that ACE inhibitors are only beneficial for certain CAD patients—those who also have ]]>heart failure]]> (a decreased ability to pump blood through the body) or a malfunctioning heart chamber called left ventricular (LV) dysfunction, which contributes to heart failure.
In an effort to determine if ACE inhibitors benefit CAD patients who do not have heart failure or LV dysfunction, a group of French researchers analyzed data from seven studies looking at this question. Their findings, in the April 10, 2006 Archives of Internal Medicine , show that ACE inhibitors significantly reduce rates of heart attack, ]]>stroke]]> , and death in people who have CAD without heart failure or LV dysfunction.
About the Study
The French researchers pooled and analyzed data from seven randomized, placebo-controlled trials investigating the effects of ACE inhibitors on patients with CAD, but without heart failure or LV dysfunction. The combined data represented 33,960 patients tracked for an average of 4.4 years. The rates of heart attack, stroke, and death were compared between patients given ACE inhibitors and those given placebo.
Compared with those taking a placebo, people receiving ACE inhibitors showed significant drops in the following CAD-related risks:
- 14% decrease in death from any cause
- 19% decrease in death from heart disease
- 18% decrease in heart attack
- 23% decrease in stroke
Like any meta-analysis, this study is limited by the flaws of the individual studies. Some were too small or too short to provide significant results when considered alone; with all the data combined, though, significant patterns emerged. In addition, five ACE inhibitors of varying doses were used across the seven studies, so specific dosing recommendations cannot be made from these findings.
How Does This Affect You?
While it has been well established that ACE inhibitors are beneficial for CAD patients with heart failure or LV dysfunction, their usefulness in CAD patients without these complications has been unclear. This study provides clarity. Based on the finding that ACE inhibitors lowered the risk of heart attack, stroke, and death among the CAD patients in this study, the authors recommend that ACE inhibitors be considered for all patients with CAD. If you have or are at risk of CAD, talk with your doctor about the benefits of drug therapy with an ACE inhibitor. Several types of drugs can treat CAD; your doctor will consider your health and risk factors to choose the most appropriate therapy for you.
For maximum benefit, drug therapy should be combined with healthful lifestyle habits. These include the following:
- Regular exercise
- Reduced intake of saturated and trans fats
- Increased intake of fresh fruits and vegetables
- Not smoking
- Achieving and maintaining a healthful weight
- Keeping blood sugar under control, if you have ]]>diabetes]]>
- Keeping blood pressure under control, if you have ]]>hypertension]]>
- Managing stress
American Academy of Family Physicians
National Heart, Lung, and Blood Institute
Danchin N, Cucherat M, Thuillez C, Durand E, Kadri Z, Steg P. Angiotensin-converting enzyme inhibitors in patients with coronary artery disease and absence of heart failure or left ventricular systolic dysfunction. Archives of Internal Medicine . 2006;166:787-796.
National Heart, Lung, and Blood Institute. Coronary artery disease. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/Cad/CAD_WhatIs.html . Accessed April 12, 2006.
U.S. National Library of Medicine. Angiotensin-converting enzyme (ACE) inhibitors (Systemic). Available at: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202044.html . Accessed April 12, 2006.
Last reviewed Apr 14, 2006 by ]]>Richard Glickman-Simon, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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