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Impact of angiotensin converting enzyme inhibition on post-coronary artery bypass interleukin 6 release

D J Brull1, J Sanders, A Rumley

  • 1UCL Centre for Cardiovascular Genetics, Rayne Institute, London, UK Department of Medicine, Glasgow Royal Infirmary, Glasgow, UK. d.brull@ucl.ac.uk

Heart (British Cardiac Society)
|February 16, 2002
PubMed

Insights

Angiotensin 1 converting enzyme (ACE) inhibitors may reduce inflammation after coronary artery bypass graft surgery (CABG). This study found ACE inhibition blunts the increase in interleukin 6 (IL-6) levels post-CABG, suggesting an anti-inflammatory effect.

Area of Science:

  • Cardiology
  • Pharmacology
  • Immunology

Background:

  • Angiotensin 1 converting enzyme (ACE) inhibitors are known to reduce morbidity and mortality following coronary artery bypass graft surgery (CABG).
  • This beneficial effect is hypothesized to stem from an anti-inflammatory action of these drugs.
  • Interleukin 6 (IL-6) is a key inflammatory marker relevant to post-surgical outcomes.

Purpose of the Study:

  • To investigate the impact of ACE inhibition on plasma concentrations of interleukin 6 (IL-6) in patients undergoing CABG.
  • To determine if ACE inhibitors modulate the inflammatory response as measured by IL-6 levels after CABG.

Main Methods:

  • A cohort of 161 patients undergoing elective first-time CABG was analyzed.
  • Patients on ACE inhibitor treatment were compared to those not on treatment after excluding those with confounding postoperative complications.
  • Plasma IL-6 levels were measured preoperatively and six hours post-CABG.

Main Results:

  • While baseline IL-6 levels were not significantly different, post-CABG IL-6 concentrations increased significantly in the overall cohort.
  • Patients receiving ACE inhibitors exhibited a blunted increase in IL-6 concentrations compared to untreated patients (median increase 117 vs. 193 pg/ml, p=0.02).
  • Peak postoperative IL-6 levels were also significantly lower in the ACE inhibitor group (p=0.02), an effect sustained after multivariate analysis (p=0.018).

Conclusions:

  • ACE inhibitor treatment is associated with a reduced interleukin 6 (IL-6) response following coronary artery bypass graft surgery (CABG).
  • These findings support the hypothesis that ACE inhibitors possess a direct anti-inflammatory effect.
  • This anti-inflammatory action may contribute to the observed clinical benefits of ACE inhibitors in the context of CABG.
Abstract

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