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Inhibition of the renin-angiotensin system for lowering coronary artery disease risk

Richard J Sheppard1, Ernesto L Schiffrin

  • 1Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, PQ, Canada.

Current Opinion in Pharmacology
|March 26, 2013
PubMed

Insights

Renin-angiotensin system inhibition is a standard therapy for reducing cardiovascular risk in high-risk individuals. This approach helps prevent coronary artery disease progression and heart disease.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology

Background:

  • The renin-angiotensin system (RAS) promotes atherosclerosis and coronary artery disease (CAD) through proliferative and pro-inflammatory effects.
  • RAS activation contributes to the progression of atherosclerosis in coronary arteries, leading to CAD.

Purpose of the Study:

  • To review the role of renin-angiotensin system inhibition in preventing coronary heart disease.
  • To summarize clinical trials investigating RAS inhibition for primary and secondary prevention of cardiovascular events.

Main Methods:

  • Review of major clinical trials evaluating angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).
  • Inclusion of trials like HOPE, EUROPA, PEACE (ACEIs), VALIANT, OPTIMAAL, TRANSCEND (ARBs), and the ongoing TOPCAT study.
  • Acknowledgment of limited data on direct renin inhibitors and angiotensin receptor/neprilysin inhibitors.

Main Results:

  • ACEIs and ARBs have been extensively studied for cardiovascular risk reduction in various patient populations.
  • Clinical trials demonstrate the efficacy of RAS inhibition in secondary prevention of coronary heart disease.
  • Data on newer RAS-targeting agents are still emerging.

Conclusions:

  • Inhibition of the renin-angiotensin system is a cornerstone of cardiovascular risk management.
  • RAS inhibition is established as standard-of-care for secondary prevention in high-risk individuals.
  • Further research is needed for novel RAS-targeting agents in cardiovascular disease prevention.

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