September 1, 2007Journal of Cardiovascular Pharmacology and Therapeutics

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

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Why the study?

Do tissue ACE inhibitors reduce mortality and cardiovascular events in patients with preserved left ventricular function and high cardiovascular risk?

Structured PICO

Do tissue ACE inhibitors reduce mortality and cardiovascular events in patients with preserved left ventricular function and high cardiovascular risk?

Population

31,555 patients (from 4 RCTs) with a prior cardiovascular event or at high risk for cardiovascular events, and preserved left ventricular function

Intervention

Tissue angiotensin-converting enzyme (ACE) inhibitors

Comparator

Placebo

Outcome

All-cause mortality, cardiovascular mortality, acute myocardial infarction, and strokehard clinical

Tissue ACE inhibitors significantly reduce mortality, myocardial infarction, stroke, and heart failure hospitalizations in patients with preserved left ventricular function and high cardiovascular risk.

Implication

Supports tissue ACE inhibitor use in high-risk preserved LVEF patients; strengthens evidence for mortality and major CV event reduction.

Abstract

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 chi2 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.