The antiatherogenic potential of blocking the renin-angiotensin system.
Angiotensin converting enzyme (ACE) inhibitors have proved effective in preventing or ameliorating clinical manifestations of atherosclerosis, such as myocardial infarction (MI) and heart failure. Experimental evidence demonstrates their anti-atherogenic potential; ACE inhibitors do not only suppress the formation of proatherogenic angiotensin II (AII), but also enhance the formation and release of anti-atherogenic nitric oxide (NO) at local tissue sites; both mechanisms are implicated in the suppression of neointima formation in the balloon-injured vessel wall. A similar anti-atherogenic potential is provided by the blockade of the renin-angiotensin system (RAS) at the level of the angiotensin type-1 (AT1) receptor. AT1 receptor antagonists do not only block the proatherogenic actions of AII, but also induce an enhanced formation and release of anti-atherogenic NO at local tissue sites. AT1 receptor antagonists may therefore prove as effective as ACE inhibitors in patients with manifest atherosclerosis.
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.
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Goetz