Overview of effects of ACE-Inhibitors on cardiovascular diseases
Angiotensin-converting-enzyme inhibitors, also known as ACE Inhibitor, are a class of medications that are used primarily for treatment of treatment of hypertension and congestive heart failure. Examples of ACE-Inhibitors include Captopril, Zofenopril, Enalapril, Ramipril, Perindopril, Lisinopril and Fosinopril. ACE inhibitors reduce arterial pressure by inhibiting angiotensin II production and increasing bradykinin and the vasodilating prostaglandins.
ACE-Inhibitors have been shown to reduce the risk of death, stroke, diabetes, myocardial infarction, nephropathy and renal impairment. ACE Inhibitors are effective for a wide range of patients including those with history of myocardial infarction, diabetes, stroke, or transient ischemic attack.
Results from the Studies Of Left Ventricular Dysfunction (SOLVD) and the Survival And Ventricular Enlargement (SAVE) trials indicated that ACE Inhibitors might reduce acute ischemic cardiovascular events by 20%.
Similarly, a meta-analysis of results from the Heart Outcomes Prevention Evaluation (HOPE) trial, the European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease (EUROPA), and the Prevention of Events with Angiotensin-Converting-Enzyme inhibition trial (PEACE) suggested that ACE inhibitors were associated with a 17% reduction in cardiovascular mortality, a 16% reduction in nonfatal MI, a 13% reduction in all-cause mortality and a 7% reduction in revascularization rate. ACE Inhibitors lead to an average reduction of 3.9 mm Hg in the systolic blood pressure and an average reduction of 1.8 mm Hg in the diastolic blood pressure.
More specifically, in the HOPE trial, 9297 patients were randomized into a treatment arm receiving ramipril and a placebo arm. Treatment with ramipril reduced the rates of death from cardiovascular causes by 26%, myocardial infarction by 20%, stroke by 32%, revascularization procedures by 16%, heart failure by 16% and diabetic complications by 16%. At two-year follow-up, the blood pressure of the treatment arm and the placebo arm are 136/76 mm Hg and 139/77 mm Hg, respectively.
It is commonly thought that all ACE inhibitors have similar effects; however, Pilote et al (2006) showed that some drugs might prevent future heart problems and death better than others. Patients who filled prescriptions for ramipril had lower death rates within the first year of hospital discharge than did those who filled prescriptions for several other ACE inhibitors. More specifically, enalapril, fosinopril, captopril, quinapril, and lisinopril were associated with higher mortality than was ramipril: the adjusted hazard ratios for these drugs in comparison to ramipril are 1.47, 1.71, 1.56, 1.58, and 1.28 respectively. Only perindopril performs slightly better than ramipril with an adjusted hazard ratio of 0.98.
“Mortality Rates in Elderly Patients Who Take Different Angiotensin-Converting Enzyme Inhibitors after Acute Myocardial Infarction: A Class Effect?” Annals of InternalMedicine (volume 141, pages 102-112). L. Pilote, M. Abrahamowicz, E. Rodrigues, M.J. Eisenberg, and E. Rahme.
Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on rena, GR Dagenais, J Pogue, K Fox, ML Simoons, S Yusuf - Lancet, 2006 - ncbi.nlm.nih.gov
Angiotensin-Converting Enzyme Inhibitors in Coronary Artery Disease and Preserved Left Ventricular … - Al-Mallah, IM Tleyjeh, AA Abdel-Latif, WD … - Journal of the American College of Cardiology