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.
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.


METHODS
Peer-reviewed journals listed in Index Medicus/MEDLINE, the Cochrane Central Register of Controlled Clinical Trials, and the Cochrane Database of Systematic Reviews.


METHODS
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.
Saha
Sandeep A
SA
Department of Medicine, Chicago Medical School, North Chicago, Illinois 60064, USA.
Molnar
Janos
J
Arora
Rohit R
RR
D000787:Angina Pectoris / Q000517:prevention & control; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000517:prevention & control; D005260:Female; D006333:Heart Failure / Q000517:prevention & control; D006760:Hospitalization; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000517:prevention & control; D009204:Myocardial Revascularization; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control*; D016277:Ventricular Function, Left
D000806:Angiotensin-Converting Enzyme Inhibitors