European Heart Journal Advance Access originally published online on August 11, 2006
European Heart Journal 2006 27(18):2154-2157; doi:10.1093/eurheartj/ehl122
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Should angiotensin-converting enzyme-inhibitors be used to improve outcome in patients with coronary artery disease and ‘preserved’ left ventricular function?
1 Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
2 University of Ferrara, Ferrara, Italy
3 McMaster University, Hamilton, Canada
4 Weill Medical College of Cornell University, New York, NY, USA
Received 19 May 2006; accepted 6 September 2006; online publish-ahead-of-print 11 August 2006.
* Corresponding author. Tel: +44 20 7351 8626; fax: +44 20 7351 8629. E-mail address: k.fox{at}rbht.nhs.uk
Abstract
Early clinical studies investigating the role of angiotensin-converting enzyme (ACE) inhibitors in the treatment of heart failure unexpectedly demonstrated a possible reduction in coronary heart disease endpoints. Two large scale clinical trials, HOPE and EUROPA, both studies in patients with coronary artery disease (CAD) but without clinical evidence of heart failure, showed a highly significant improvement in coronary heart disease outcomes on treatment with ramipril and perindopril, respectively, in contrast, in a similar population, PEACE was unable to demonstrate such benefit with trandolapril. Meta-analyses of all trials involving ACE-inhibitors showed a highly significant improvement in coronary heart disease endpoints. Current ESC guidelines recommend ACE-inhibitor therapy in CAD patients with co-existing indications for ACE-inhibitors, such as hypertension, heart failure, left ventricular dysfunction, prior MI was left ventricular dysfunction, or diabetes (class I, level of evidence A). These guidelines also recommend ACE-inhibitor therapy in all patients with angina and proven coronary disease (class IIa, level of evidence B). However, in angina patients without independent indication for ACE-inhibitor treatment, the anticipated benefit should be weighted against the costs and risks of side effects; in these patients, only agents and doses of proven efficacy for secondary prevention should be employed.
Key Words: ACE inhibitors • Stable coronary artery disease • Secondary prevention •
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 Authors/Task Force Members, J.-P. Bassand, C. W. Hamm, D. Ardissino, E. Boersma, A. Budaj, F. Fernandez-Aviles, K. A.A. Fox, D. Hasdai, E. M. Ohman, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology Eur. Heart J., July 1, 2007; 28(13): 1598 - 1660. [Full Text] [PDF]
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