title: Imagine how many lives you save: angiotensin-converting enzyme inhibition for atherosclerotic vascular disease in the present era of risk reduction.
abstract: BACKGROUND
  Angiotensin-converting enzyme (ACE) inhibition is clearly beneficial in patients with hypertension, heart failure, and post-myocardial infarction left ventricular (LV) dysfunction. However, whereas initial trials had reported a benefit of ACE inhibition in high-risk vascular patients, current trials of ACE inhibition have failed to demonstrate a clear benefit in vascular patients who are receiving risk-reduction interventions. The purpose of this review is to analyze the reasons behind the failure of the most recent trials of ACE inhibitors in vascular patients without overt LV dysfunction. The reader will gain an understanding of the time-dependent trend towards a reduction in the absolute benefit conferred by ACE inhibition in patients with vascular atherosclerosis as risk reduction interventions are increasingly implemented.
  
  
  METHODS
  Major trials with a follow-up period of at least 1 year assessing the use of ACE inhibitors in patients with a history of cardiac or vascular events were identified via a PubMed literature search. All-cause and cardiovascular mortality outcomes were reported for each trial, as well as the use of aspirin, lipid-lowering drugs and β-blockers, and the mean LV ejection fraction.
  
  
  CONCLUSIONS
  The findings of recent trials do not support the use of ACE inhibitors in vascular patients who, adherent with risk reduction therapy, do not have hypertension, diabetes, or LV dysfunction.
authors.affiliation: Cardiology Intensive Care Unit, Hôpital Cardiologique, Bd Pr J. Leclercq, 59000 Lille, France. ennezat@yahoo.com
authors.forename: Pierre Vladimir
authors.initials: PV
authors.lastname: Ennezat
authors.forename: Claire
authors.initials: C
authors.lastname: Vannesson
authors.forename: Nadia
authors.initials: N
authors.lastname: Bouabdallaoui
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Maréchaux
authors.forename: Philippe
authors.initials: P
authors.lastname: Asseman
authors.forename: Thierry H
authors.initials: TH
authors.lastname: LeJemtel
mesh_terms: D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000188:drug therapy* / Q000401:mortality; D002986:Clinical Trials as Topic; D006801:Humans; D039781:PubMed; D018570:Risk Assessment; D040242:Risk Reduction Behavior; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors