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Angiotensin converting enzyme inhibition and coronary artery disease
1Division of Cardiology, University of Florida College of Medicine, Gainesville 32610.
Purpose:
To review the evidence on the effects of angiotensin converting enzyme (ACE) inhibitors in coronary artery disease.
Experimental Studies:
In studies of experimental atherosclerosis involving hypertensive and normotensive hyperlipidemic animals, ACE inhibitors have had potent anti-atherogenic effects, reducing the total aortic intimal surface involved and the aortic cholesterol content. In balloon-injured animals, ACE inhibitors have suppressed the myointimal proliferative response in rats and rabbits, but not in higher species such as pigs and baboons, indicating possible species-specific effects. In spontaneously hypertensive rats, ACE inhibitors have modulated alterations in endothelium-related vasodilation, although similar effects have not been observed in human hypertension.
Clinical Studies:
ACE inhibition has not been shown to prevent restenosis after percutaneous transluminal coronary angioplasty. However, cardiac ischemic events have been prevented by ACE inhibition in patients with coronary artery disease and left ventricular dysfunction in a number of studies, including the Studies of Left Ventricular Dysfunction (SOLVD), Survival and Ventricular Enlargement (SAVE) study, Acute Infarction and Ramipril Efficacy (AIRE) study and the Gruppo Italiano per lo Studio della Streptochinesi dell'Infarto Micardico 3 (GISSI-3) trial. Other ongoing studies such as the QUinapril Ischemic Event Trial (QUIET) are assessing ACE inhibitor effects in patients with coronary artery disease and a normal left ventricular function.
Conclusions:
ACE inhibitors prevent the development of atherosclerosis in hyperlipidemic animal models. They also prevent the myointimal proliferative response to injury in some animal models, but not in higher animal species or in humans. They can reduce the number of cardiac ischemic events in patients with coronary artery disease and left ventricular dysfunction; their effects in those patients with a normal left ventricular function are now being assessed.
Insights
Angiotensin converting enzyme (ACE) inhibitors show anti-atherogenic effects in animal models and prevent cardiac ischemic events in patients with coronary artery disease and left ventricular dysfunction.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Coronary artery disease (CAD) involves complex pathological processes.
- Angiotensin converting enzyme (ACE) inhibitors are a class of drugs with known cardiovascular benefits.
Purpose of the Study:
- To review the evidence on the efficacy of ACE inhibitors in managing coronary artery disease.
- To evaluate the anti-atherogenic and cardioprotective effects of ACE inhibitors.
Main Methods:
- Review of experimental studies in animal models of atherosclerosis and vascular injury.
- Analysis of clinical trial data investigating ACE inhibitors in patients with CAD and varying degrees of left ventricular function.
Main Results:
- ACE inhibitors demonstrated potent anti-atherogenic effects in hyperlipidemic animal models, reducing atherosclerotic burden and cholesterol content.
- In animal models of vascular injury, ACE inhibitors suppressed myointimal proliferation, though effects varied by species.
- Clinical studies show ACE inhibitors prevent cardiac ischemic events in patients with CAD and left ventricular dysfunction.
Conclusions:
- ACE inhibitors possess anti-atherogenic properties in preclinical models.
- While effective in preventing cardiac events in specific patient groups, their role in restenosis and in patients with normal left ventricular function requires further assessment.