Improved fibrinolysis after one year of treatment with enalapril in men and women with uncomplicated myocardial infarction.
OBJECTIVE
To study long-term effects of enalapril on mass concentrations of tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI-1), tPA/PAI-1-complex and von Willebrand factor (vWF) in both genders with uncomplicated myocardial infarction.


RESULTS
More than three months after an uncomplicated myocardial infarction 82 survivors (46 males, 36 females) were randomised to enalapril/placebo. PAI-1, tPA, tPA/PAI-1-complex and vWF were measured after two weeks, six and 12 months following randomisation. PAI-1 decreased significantly in both genders in the enalapril-treated group after two weeks, with a maximum decrease at six months (mean reduction: 31% equal to 9.8 microg x L(-1), CI: 5.2 to 14.5 microg x L(-1), p = 0.0001) and remained significantly lower at 12 months. Mass concentration of tPA decreased significantly (mean reduction: 1.81 microg x L(-1), CI: 0.903 to 2.708 microg x L(-1), p < 0.001) after two weeks treatment in both genders but returned to baseline values at 12 months. The tPA/PAI-1-complex decreased and was significantly lower (mean reduction 0.96 microg x L(-1), CI: 0.36 to 1.56 microg x L(-1), p = 0.003) in the enalapril group after two weeks and six months (p = 0.037). No decrease of vWF was seen in the enalapril group.


CONCLUSIONS
Enalapril treatment up to one year depressed mass concentrations of PAI-1 and transiently tPA and tPA/PAI-1 complex indicating an improvement of the fibrinolytic balance in both genders with uncomplicated myocardial infarction.
Boman
Kurt O A
KO
Department of Medicine and Genetics, Skellefteå County Hospital, Institution of Public Health and Clinical Medicine, Umeå University, Skellefteå, Sweden. kurt.boman.ss@vll.se
Jansson
Jan-Håkan
JH
Nyhlén
Katarina A
KA
Nilsson
Torbjörn K
TK
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D015415:Biomarkers; D004311:Double-Blind Method; D004656:Enalapril / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D005500:Follow-Up Studies; D006801:Humans; D046911:Macromolecular Substances; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D012307:Risk Factors; D012737:Sex Factors; D010959:Tissue Plasminogen Activator / Q000032:analysis; D014841:von Willebrand Factor / Q000032:analysis
D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D046911:Macromolecular Substances; D017395:Plasminogen Activator Inhibitor 1; D014841:von Willebrand Factor; D004656:Enalapril; D010959:Tissue Plasminogen Activator