ACE Inhibitors Help All Heart Patients
Even Those With Moderate Risk or Already on Other Medications May Benefit, Study Shows
Aug. 10, 2006 - Even moderate-risk heart patients already taking other
medications to protect against heart attacks and strokes can benefit from
adding an ACE inhibitor to the mix, a new analysis finds.
Researchers concluded that for every 1,000 patients treated with an ACE
inhibitor for 4.5 years, 21 serious events such as heart
The analysis appears in the Aug. 12 issue of The Lancet.
ACE inhibitors are a class of medications widely prescribed for patients
failure and for other high-risk heart patients, such as those with
Heart failure means the heart muscle's pumping strength has weakened. There
are a number of causes for heart failure; having a heart attack is one.
It has been unclear if these drugs benefit patients who do not have heart
failure but have atherosclerosis (hardening of the arteries), with a
moderate-to-low risk of having a heart attack or stroke.
Three large studies conducted since the mid-1990s attempted to answer this
Revisiting the Data
Two studies found ACE inhibitors helped protect moderate-risk patients with
hardening of the arteries, but not heart failure. One found no benefit.
In an effort to make sense of the seemingly paradoxical findings,
researchers combined and reanalyzed the three trials, known individually as the
HOPE, EUROPA, and PEACE studies.
The researchers concluded that the addition of an ACE inhibitor reduced the
risk of death from any cause -- heart failure, heart attack, or stroke -- even
among very low-risk patients and those taking other heart-protecting drugs like
low-dose aspirin, cholesterol-lowering statins, and beta- blockers.
"Even the low-risk patients with heart diseasein
these trials benefited," Gilles R. Dagenais, MD, one of the researchers,
Analyzing the Benefits of ACE Inhibitors
The new analysis conflicts with the finding of the PEACE study
investigators, who concluded ACE inhibitors were no better than a placebo for
lowering the risk of heart attackin
patients with stable coronary artery disease already taking other
At the time, PEACE researchers suggested the lack of benefit could be
explained by the fact that their study included lower risk patients than the
other two trials, and that more of their patients were taking statins to lower
their LDL "bad" cholesterol.
But when Dagenais and colleagues controlled for these differences, they
concluded this was not the case.
They found patients who had a very low risk of having a heart attack or stroke-- even
those whose risk was as low as 1.7% per year - lowered the risk even further
when they took an ACE inhibitor.
"The use of ACE inhibitors should be considered in all patients with
vascular disease [atherosclerosis] as long as they can tolerate these agents
and the absolute benefits are judged to be valuable," they write.