ACE Inhibitors Good for Hardened Arteries

While some doctors still debate the practice, new research finds benefits

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By Ed Edelson
HealthDay Reporter

FRIDAY, Aug. 11, 2006 (HealthDay News) -- Reopening an old debate, Canadian researchers say that ACE inhibitors -- drugs generally prescribed for heart failure -- can help people with the "hardening of the arteries" called atherosclerosis.

A "meta-analysis" of three major studies done years ago shows a benefit from ACE-inhibitor treatment in terms of reduced deaths from heart disease and a lower risk of heart attack and stroke in patients with atherosclerosis, said the report by researchers at the Laval University Heart and Lung Institute, in Quebec.

Two of the three studies, involving nearly 30,000 people, clearly showed such a benefit, said Dr. Gilles R. Dagenais, a cardiologist at the institute and a member of the research team. And while the third study did not, it had flaws that open it to criticism, he said.

The two studies showing a benefit looked at the incidence of heart attacks, stroke and overall deaths from heart disease. The third study -- PEACE, for Prevention of Events with ACE Inhibition -- also looked at the incidence of procedures such as angioplasty to open blocked arteries in patients with atherosclerosis, Dagenais said, and that was "a subjective criterion, not a strong, robust outcome like death, a nonfatal myocardial infarction [heart attack] or stroke."

The conclusion, Dagenais said, is that ACE inhibitors should be prescribed "for patients who have coronary heart disease and also atherosclerosis in major arteries, such as those in the brain, if there are no contraindications and if the physician judges there is benefit."

The findings were expected to be published in the Aug. 12 issue of the journal The Lancet.

But to show that the debate still simmers, an accompanying editorial by two Italian cardiologists cited the PEACE trial results to argue against routine use of ACE inhibitors in such cases.

All things considered, the Canadian interpretation probably is correct, said Dr. Gary Francis, head of the Cleveland Clinic clinical cardiology section, who has studied the issue.

The meta-analysis of the three studies was done by a group "highly qualified to do such studies," Francis said, but "like all meta-analyses, it has some problems. It would be naive to believe that a meta-analysis would have power over a randomized, controlled study."

While "we don't think we have a definitive answer on the issue and probably will never have a definitive answer, the preponderance of the evidence is in favor of using ACE inhibitors for atherosclerosis," Francis said.

No cardiologist would prescribe the drugs for all such patients, he added. Some people might have an allergic reaction to the drugs, and some elderly people with low blood pressure might be made dizzy by them.

Still, "I have a low threshold to go to ACE inhibitors because there is a low price to pay for their benefits," Francis said. "They should be considered for all patients with atherosclerosis."

More information

Learn all about ACE inhibitors from the National Library of Medicine.

SOURCES: Gilles R. Dagenais, M.D., cardiologist, Laval University Heart and Lung Institute, Quebec, Canada; Gary Francis, head, Cleveland Clinic clinical cardiology section; Aug. 12, 2006, The Lancet

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