title: Current perspective on the use of angiotensin-converting enzyme inhibitors in the management of coronary (atherosclerotic) artery disease.
abstract: OBJECTIVE
  To review the pathophysiology of atherosclerosis, the role of the renin-angiotensin system in atherogenesis, and studies supporting the potential beneficial effects of angiotensin-converting enzyme (ACE) inhibitors in reducing cardiovascular events with long-term use.
  
  
  BACKGROUND
  Through its action in converting angiotensin I to angiotensin II and by degrading bradykinin, local tissue ACE exerts many effects that can contribute to the development of atherosclerosis. Therefore, the use of ACE inhibitors can possibly result in antiatherogenic effects. Possible mechanisms for antiatherogenic effects of ACE inhibitors include: (1) reduction of blood pressure; (2) antiproliferative and antimigratory effects on vascular smooth muscle cells, neutrophils, and monocytes; (3) restoration of endothelial function; (4) stabilization of fatty plaque by preventing vasoconstriction; (5) antiplatelet effects; and (6) enhancement of endogenous fibrinolysis.
  
  
  METHODS
  English-language clinical studies, abstracts, and review articles pertaining to the use of ACE inhibitors and atherosclerosis.
  
  
  METHODS
  Relevant human studies examining the role of ACE inhibitors and atherosclerosis.
  
  
  RESULTS
  Studies evaluating the possible beneficial effects of ACE inhibitors in the development of atherosclerosis are reviewed and critiqued. Design of ongoing studies with clinical and surrogate end points are discussed.
  
  
  CONCLUSIONS
  Based on current published studies, recommendations are made regarding the use of ACE inhibitors in atherosclerosis. Therapeutic monitoring parameters for efficacy and adverse effects are also reviewed.
authors.affiliation: Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY 11201, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Cheng
authors.forename: M N
authors.initials: MN
authors.lastname: Ngo
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000818:Animals; D001161:Arteriosclerosis / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D006801:Humans; D012084:Renin-Angiotensin System / Q000502:physiology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors