Do ACE inhibitors modulate atherosclerosis?

Area of Science:

• Cardiovascular Research
• Pharmacology
• Vascular Biology

Background:

• The renin-angiotensin-aldosterone system, including angiotensin II and bradykinin, plays a crucial role in atherosclerosis development.
• Laboratory studies indicate ACE inhibitors possess antiproliferative, anti-inflammatory, and vasodilatory effects beneficial for atherosclerosis and post-angioplasty restenosis.

Purpose of the Study:

• To evaluate the potential of ACE inhibitors in modulating the atherosclerotic process.
• To explore discrepancies between extensive animal data and sparse clinical evidence regarding ACE inhibitor efficacy.

Main Methods:

• Review of experimental data on ACE/angiotensin II/bradykinin system in atherosclerosis.
• Comparison of animal models and clinical studies concerning ACE inhibitor administration and efficacy.
• Analysis of theoretical advantages of ACE inhibitors over angiotensin II-receptor blockers.

Main Results:

• Animal studies suggest ACE inhibition can counteract endothelial dysfunction, delay lesion formation, and reduce myointimal proliferation.
• Clinical evidence supporting these benefits, particularly post-percutaneous coronary intervention restenosis, remains limited.
• ACE inhibitors may offer advantages over angiotensin II-receptor blockers due to their effects on bradykinin.

Conclusions:

• While animal data strongly support ACE inhibitors' anti-atherosclerotic potential, clinical validation is sparse and requires targeted trials.
• Further investigation is urgently needed to confirm the efficacy of ACE inhibitors across the atherosclerotic spectrum.
• The TREND study may offer insights, but definitive conclusions on ACE inhibitors' role in atherosclerosis await further clinical evidence.