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European Heart Journal Advance Access published online on August 11, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl122
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received May 19, 2006
Accepted September 6, 2006

Current opinion

Should angiotensin-converting enzyme-inhibitors be used to improve outcome in patients with coronary artery disease and ‘preserved’ left ventricular function?

Kim Fox 1 *, Roberto Ferrari 2, Salim Yusuf 3, and Jeffrey S. Borer 4

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

* To whom correspondence should be addressed.
Kim Fox, E-mail: 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.

Keywords: ACE inhibitors; Stable coronary artery disease; Secondary prevention; 0.
The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.
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