April 10, 2012

The ACE Inhibitors Study in Angina

Source: Scottish Intercollegiate Guidelines Network, Management of stable angina A national clinical guideline, February 2007

Grades of Recommendation: All patients with stable angina should be considered for treatment with angiotensin converting enzyme inhibitors.

Conclusion: ACE inhibitors significantly reduced all cause and cardiovascular mortality

HOPE Study
involved 9,297 high-risk patients with vascular disease or diabetes plus one other cardiovascular risk factor without history of heart failure or left ventricular dysfunction

Ramipril was associated with significant reductions in all-cause mortality, myocardial infarction and stroke in these patients


use of perindopril in the EUROPA study involving 13,655 patients with stable coronary disease and no clinical evidence of heart failure reduced the risk of cardiovascular death, myocardial infarction or cardiac arrest

significant reduction in cardiovascular events is mainly due to the reduction in the incidence of non-fatal myocardial infarction

The effect on all-cause mortality did not reach a statistically significant level. Subgroup analysis of the trial showed that benefit from perindopril is mainly in patients with history of myocardial infarction

PEACE trial

using trandolopril of 8,290 patients with no history of clinical heart failure or echocardiographic evidence of left ventricular systolic dysfunction did not reveal any benefit on cardiovascular events although the event rate was unexpectedly low


1,750 patients with coronary heart disease and normal left ventricular function found that the ACE inhibitor quinapril did not significantly affect clinical outcomes or the progression of coronary atherosclerosis

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