Years of cholesterol-laden fast food and couch-potato
living have taken their toll on Eddy Velasquez. The 50-year-old has coronary artery
disease (CAD). "My doc says my condition is stable," says Eddy. "Still, I'm plenty
scared and want to do what I can to make things better. I've heard that ACE inhibitors
may be good for someone like me." Eddy may be disappointed to hear the latest
news on these drugs. A randomized study just published in the November 11 issue
of the New England Journal of Medicine (NEJM) documents how angiotensin-converting
enzyme (ACE) inhibitors, in particular trandolapril, commonly prescribed for the
treatment of hypertension, don't benefit some folks with stable CAD. PLAN
FOR PEACE
ACE inhibitors are known to reduce such risks "in patients
with left ventricular systolic dysfunction or heart failure," according to the
authors of the NEJM study. As well, the drugs can minimize complications
arising from fatty build-up on arterial walls in folks who have vascular disease
but whose hearts are working satisfactorily. So Dr Eugene Braunwald of Boston's
Harvard Medical School and colleagues from the Prevention of Events with Angiotensin
Converting Enzyme Inhibition (PEACE) trial decided to see whether the addition
of ACE inhibitors to conventional therapy would help low-risk patients. This group
of individuals had stable CAD and a normal or only marginally reduced functioning
of the heart's left ventricle. The trial involved 8,290
patients with a mean age of 64 years. Seventy percent were taking drugs to curb
their lipid levels and 72% had undergone coronary revascularization. Both the
patients and the investigators were unaware who was receiving the ACE inhibitor
trandolapril or placebo. Baseline measurements of mean blood pressure and heart
function (left ventricular ejection) were established in all subjects. The rates
of nonlethal heart attack, death due to a malfunctioning heart or blood vessels,
and incidences where blocked blood vessels had to be reopened surgically, were
noted over the course of the trial. Over almost five
years, 21.9% of the patients taking trandolapril died from coronary revascularization,
heart attack, or other heart or blood vessel malfunctions. The death rate from
these causes in the placebo group was pretty similar at 22.5%. F-ACE
THE MUSIC
"In patients with stable coronary heart disease and preserved
left ventricular function who are receiving current standard therapy and in whom
the rate of cardiovascular events is lower than in previous trials of ACE inhibitors
in patients with vascular disease, there's no evidence that the addition of an
ACE inhibitor provides further benefit in terms of death from cardiovascular causes,
myocardial infarction or coronary revascularization," conclude the authors of
the NEJM paper. However, they note "physicians
may still wish to consider ACE inhibitor therapy for any patient who does not
clearly fit the profile of patients in this trial." In an accompanying editorial,
Dr Bertram Pitt, of the University of Michigan School of Medicine in Ann Arbor,
describes the results as "surprising," given what's known about how ACE inhibitors
work. As a result of the study, he says, "I will no longer recommend an ACE inhibitor
to patients like those included in the PEACE trial."
|
