This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via ISI Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Saha, S. A. Articles by Arora, R. R. Search for Related Content PubMed PubMed Citation Articles by Saha, S. A. Articles by Arora, R. R. Social Bookmarking                   What's this?

Tissue ACE Inhibitors for Secondary Prevention of Cardiovascular Disease in Patients With Preserved Left Ventricular Function: A Pooled Meta-analysis of Randomized Placebo-controlled Trials

Department of Medicine, Chicago Medical School, North Chicago, Illinois

Janos Molnar, MD

Department of Medicine, Chicago Medical School, North Chicago, Illinois

Rohit R. Arora, MD, FACC, FAHA

Department of Medicine, Chicago Medical School, North Chicago, Illinois, rohit.arora{at}med.va.gov

Objective. A pooled meta-analysis of published, randomized placebo-controlled clinical trials to evaluate the role of tissue angiotensin-converting enzyme (ACE) inhibitors in secondary prevention of cardiovascular disease in patients with preserved left ventricular function. Sources. Peer-reviewed journals listed in Index Medicus/MEDLINE, the Cochrane Central Register of Controlled Clinical Trials, and the Cochrane Database of Systematic Reviews. Study selection . Randomized placebo-controlled clinical trials of at least 12 months' duration, in patients with a prior cardiovascular event or at high risk for cardiovascular events, were analyzed. Data synthesis and analysis. A total of 31 555 patients (136 882 patient-years) from 4 trials were selected for the meta-analysis. Relative risk estimations were made using data pooled from these trials, and statistical significance was determined using the 2 test. The number of patients needed to treat was also calculated for each outcome. Results. Tissue ACE inhibitors significantly reduced the risk of all-cause mortality, cardiovascular mortality, acute myocardial infarction, and stroke (P < .001 for each). The need for invasive coronary revascularization was reduced (P = .03), as was the risk of hospitalization for congestive heart failure (P = .001). The occurrence of new-onset diabetes was also significantly reduced (P < .001), but the risk of hospitalization for angina was not significantly affected (P = .677). Treating about 100 patients for about 4.5 years would prevent 1 death, 1 non-fatal myocardial infarction, 1 cardiovascular death, or 1 invasive coronary revascularization. Conclusions. Tissue ACE inhibitors have demonstrated benefit when used for secondary prevention of cardiovascular disease in patients with preserved left ventricular function in randomized placebo-controlled clinical trials.

Key Words: tissue ACE inhibitors • prevention • meta-analysis • preserved ventricular function

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?