title: Effects of low-dose angiotensin II receptor blocker candesartan on cardiovascular events in patients with coronary artery disease.
abstract: OBJECTIVE
  The purpose of this study was to investigate the effects of angiotensin II receptor blockers on the prevention of cardiovascular events in patients with coronary artery disease (CAD).
  
  
  BACKGROUND
  Angiotensin II may contribute to the pathogenesis of CAD. Long-term clinical trials have shown that blockade of the renin-angiotensin system can reduce cardiovascular events in patients with acute myocardial infarction complicated by heart failure.
  
  
  METHODS
  Patients with a history of coronary intervention and no significant coronary stenosis on follow-up angiography 6 months after intervention were randomly assigned into a candesartan group (n = 203; baseline treatment plus candesartan 4 mg/d) or a control group (n = 203; baseline treatment alone). The primary end point was a composite of revascularization, nonfatal myocardial infarction, or cardiovascular death. The secondary end point was hospitalization for cardiovascular causes.
  
  
  RESULTS
  There were no changes in blood pressure and in other coronary risk factors in either group during a mean follow-up of 24 months. Primary end point risk was significantly lower in the candesartan group (n = 12) than in control group patients (n = 25) (P =.03). Candesartan treatment reduced primary end point risk (5.9% vs 12.3% for control subjects; relative risk, 0.47; 95% CI, 0.24 to 0.93). The incidence of all events including secondary end points and noncardiovascular death was significantly lower in the candesartan group than in control group patients (23 vs 40 cases) (P =.02).
  
  
  CONCLUSIONS
  Relatively low-dose candesartan, which did not alter blood pressure levels, reduces cardiovascular risk in high-risk patients with CAD.
authors.affiliation: Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Kondo
authors.forename: Takahito
authors.initials: T
authors.lastname: Sone
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tsuboi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Mukawa
authors.forename: Itsuro
authors.initials: I
authors.lastname: Morishima
authors.forename: Michitaka
authors.initials: M
authors.lastname: Uesugi
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kono
authors.forename: Takashi
authors.initials: T
authors.lastname: Kosaka
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Yoshida
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Numaguchi
authors.forename: Hideo
authors.initials: H
authors.lastname: Matsui
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
authors.forename: Kenji
authors.initials: K
authors.lastname: Okumura
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000209:etiology / Q000517:prevention & control; D057911:Angiotensin Receptor Antagonists; D001562:Benzimidazoles / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D003327:Coronary Disease / Q000188:drug therapy*; D016757:Death, Sudden, Cardiac; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D009204:Myocardial Revascularization; D011446:Prospective Studies; D013223:Statistics as Topic; D013777:Tetrazoles / Q000627:therapeutic use*
chemical_list: D057911:Angiotensin Receptor Antagonists; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan