Do ACE inhibitors prolong the life of cats with asymptomatic hypertrophic cardiomyopathy?

Archie, a four-year-old male neutered Maine coon, is presented to you for his annual booster vaccination. His owner reports that he seems in good health, and they have no concerns about him. However, upon clinical examination, you hear a grade 2/6 heart murmur. You discuss this with the owner, and they report that Archie's littermate sadly died due to heart disease. Archie has an echocardiogram and is diagnosed with significant hypertrophic cardiomyopathy (HCM). Given this is the same condition his littermate had, the owner is extremely worried and keen to explore any options that may extend his life expectancy. You are aware that the angiotensin-converting enzyme (ACE) inhibitor benazepril has historically been used to treat heart disease in cats and is licensed for the treatment of feline HCM in Australia. You wonder if treating Archie with benazepril before he begins to show clinical signs will help slow the progression of the disease. In [cats with asymptomatic hypertrophic cardiomyopathy], does [treatment with an ACE inhibitor versus no treatment] [improve life expectancy]? Search last performed: 29 June 2024 The search identified a study evaluating the effects of benazepril in cats with heart disease that included a proportion of cats with asymptomatic HCM.1 However, it was not possible to separate the results specifically relating to these cats from those relating to cats with other causes of heart disease. Therefore, this paper could not answer the question and was excluded. No studies were found that answered the question of whether ACE inhibitors improve life expectancy in cats with asymptomatic HCM. There are published papers that focus on other outcomes of ACE inhibitor treatment (eg, echocardiographic parameters) and other cardiac diseases, but these are outside the scope of the present evidence evaluation. Other resources, such as textbooks, expert opinion, narrative reviews and online sites, can be useful when peer-reviewed evidence is scarce. However, there needs to be an appreciation of the limitations of using these evidence sources in clinical decision making. Furthermore, it should be noted that while benazepril is licensed for the treatment of feline HCM in Australia, it is not licensed for this purpose in the UK. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. The 'Evaluating The Evidence' section of Vet Record aims to answer specific clinical questions using a systematic approach to identify and succinctly summarise the relevant evidence from the scientific literature. The shortcomings of this evidence are also taken into account, thereby enabling vets to incorporate the best available evidence from the literature when making clinical decisions. Please contact us at [email protected] if you have an article you would like us to consider for publication in this section.