Do ACE inhibitors improve outcome in patients with stable vascular disease?

Lars Køber and Christian Torp-Pedersen*

This article has no abstract so we have provided the first paragraph of the full text.

In recent years, three large studies have addressed whether patients with chronic ischemic heart disease (IHD)—but without HF or LVSD—should be treated with an ACE inhibitor. In the HOPE study,¹ 85% of patients had IHD, left ventricular (LV) function was not measured, and lipid-lowering therapy was given to 29% of patients. Furthermore, many patients in HOPE had diabetes and hypertension. The annual placebo mortality was approximately 2.5%, and ramipril reduced both mortality and cardiovascular events. In the EUROPA trial,² all patients had IHD, again LV function was not estimated, and lipid-lowering therapy was given to 58% of patients. The placebo annual mortality was approximately 1.8% and perindopril lowered the incidence of a combined cardiovascular end point, but did not significantly impact all-cause mortality. The PEACE trial³ included patients with IHD, largely from the US, LV ejection fraction was measured and was above 40% in all patients, and 70% of trial participants received a lipid-lowering drug. The annual mortality was approximately 1.6% and trandolapril did not influence cardiovascular outcome or mortality.

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