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Angiotensin-converting-enzyme inhibitors in stable vascular disease without left ventricular systolic dysfunction or heart failure: a combined analysis of three trials
- Source :
- Lancet (UK), 368(9535), 581-588. Elsevier Ltd.
- Publication Year :
- 2006
- Publisher :
- Elsevier Ltd., 2006.
-
Abstract
- Angiotensin-converting-enzyme (ACE) inhibitors reduce cardiovascular mortality and morbidity in patients with heart failure or left ventricular systolic dysfunction (LVSD). Three large trials have assessed the effect of ACE inhibitors in stable patients without these conditions but with atherosclerosis. We undertook a systematic review of the Heart Outcomes Prevention Evaluation (HOPE), the European trial on Reduction Of cardiac events with Perindopril among patients with stable coronary Artery disease (EUROPA), and the Prevention of Events with ACE inhibition (PEACE) studies to determine the consistency with which ACE inhibitors reduce total mortality and fatal and non-fatal cardiovascular events.We computed cardiovascular outcomes and total mortality in the 29,805 patients of these three trials, randomly assigned an ACE inhibitor or placebo and followed up for a mean of about 4.5 years. The results were also analysed within the context of five large trials of ACE inhibitors in patients with heart failure or LVSD.When the findings of the HOPE, EUROPA, and PEACE trials were combined, ACE inhibitors significantly reduced all-cause mortality (7.8 vs 8.9%, p=0.0004), cardiovascular mortality (4.3 vs 5.2%, p=0.0002), non-fatal myocardial infarction (5.3 vs 6.4%, p=0.0001), all stroke (2.2 vs 2.8%, p=0.0004), heart failure (2.1 vs 2.7%, p=0.0007), coronary-artery bypass surgery (6.0 vs 6.9%, p=0.0036) but not percutaneous coronary intervention (7.4 vs 7.6%, p=0.481). The composite outcomes of cardiovascular mortality, non-fatal myocardial infarction, or stroke occurred in 1599 (10.7%) of the patients allocated ACE inhibitor and in 1910 (12.8%) of those allocated placebo (odds ratio, 0.82; 95% CIs 0.76-0.88; p0.0001). Except for stroke and revascularisation, these results were similar to those of the five trials in patients with heart failure or LVSD.ACE inhibitors reduce serious vascular events in patients with atherosclerosis without known evidence of LVSD or heart failure. Results showing these benefits in intermediate-risk patients complement existing evidence of similar benefit in higher-risk patients with LVSD or heart failure. Therefore, use of ACE inhibitors should be considered in all patients with atherosclerosis.
- Subjects :
- Ramipril
Adult
Male
medicine.medical_specialty
Heart disease
Angiotensin-Converting Enzyme Inhibitors
Blood Pressure
Coronary artery disease
Risk Factors
Internal medicine
Perindopril
Medicine
Humans
Myocardial infarction
Coronary Artery Bypass
Randomized Controlled Trials as Topic
biology
business.industry
Angiotensin-converting enzyme
General Medicine
Middle Aged
medicine.disease
Cardiovascular Diseases
Heart failure
ACE inhibitor
biology.protein
Cardiology
Female
business
medicine.drug
Follow-Up Studies
Subjects
Details
- ISSN :
- 1474547X and 01406736
- Volume :
- 368
- Issue :
- 9535
- Database :
- OpenAIRE
- Journal :
- The Lancet
- Accession number :
- edsair.doi.dedup.....a060fb8de228939cb5a4c2d92c475b6d