Common Drugs Lower Heart Disease Deaths

Sept. 3, 2003 -- Taking an often-prescribed drug for high blood pressure can help people with heart disease reduce their risk of dying by 20% -- even those with mild heart disease.

So concludes a major new study that estimates that the addition of a daily ACE inhibitor to other heart disease treatments such as aspirin, cholesterol-lowering statins, and beta-blockers could save the lives of one of every 50 heart patients and prevent 250,000 heart attacks each year in the U.S.

"This is one of those trials that comes along every few years that really helps define medical practice," says Robert O. Bonow, MD, chief of cardiology at Northwestern Memorial Hospital in Chicago and immediate past president of the American Heart Association.

Bonow, who was not involved in the study, tells WebMD that the findings produced by the EUROPA study -- published in this week's Lancet -- should push the popular high blood pressure medications to first-line status in treating varying degrees of heart disease -- from people with stable angina to those who have had a heart attack.

Ace Inhibitors for Everyone?

ACE inhibitors widen the blood vessels to lower blood pressure and increase blood flow. They are already standard heart disease treatment for many patients -- those over age 55, those with heart failure, and others at high risk of dying from complications, such as stroke survivors and those with diabetes or high blood pressure.

But based on this study, which involved more than 12,000 patients from 24 countries, the drugs may soon be recommended for all patients with heart disease no matter how severe.

"Up until now, we've had some tantalizing evidence that ACE inhibitors should be a strong recommendation, but until now, they've been something of a weaker recommendation," he says. "Every patient with coronary disease should be on aspirin, and most on a statin and one could argue, also a beta-blocker. Now, based on this important finding, an ACE inhibitor should be one of the top three or four drugs taken by every patient."

In the study, patients were assigned either a placebo or a daily 8 mg dose of the ACE inhibitor Aceon. The patients were age 18 and older and had different severities of disease but did not have heart failure or seriously high blood pressure.

During the four years of the study, 10% of those on placebo and 8% taking Aceon died from heart disease, had a heart attack, or had to be resuscitated after cardiac arrest. Researchers say that translates to a 20% reduced risk of problems from taking the ACE inhibitor. All patients continued other heart disease treatments, including aspirin, cholesterol-lowering statins, and beta-blockers.

The protective effect from ACE inhibitors was seen in patients with varying levels of heart disease severity regardless of whether they also had high blood pressure, diabetes, or other risk factors.