Abstract 3727: Progression of Coronary Atherosclerosis: Do ACE Inhibitors Make a Difference?
Background: The mortality benefit of angiotensin-converting enzyme (ACE) inhibitor therapy in patients with coronary artery disease is commonly attributed to a specific coronary anti-atherosclerotic action. However, such an effect has never been demonstrated in human coronaries.
Objective: To evaluate the coronary anti-atherosclerotic potential of ACE inhibitors by using serial intravascular ultrasound (IVUS).
Methods: 1520 patients completing the four major IVUS trials reported to date (REVERSAL, CAMELOT, ACTIVATE and ASTEROID trials) were included in a meta-analysis. ACE inhibitor therapy was one of the treatment arms in the CAMELOT trial, while it was left to the discretion of the treating physician in other trials. All patients had angiographically documented coronary artery disease. The progression rate of disease (annualized change in total and percent atheroma volume) was compared in patients having and not having ACE inhibitors, after adjusting for possible confounders.
Results: 748 patients (49%) were on ACE inhibitors. Predictably, patients on ACE inhibitors were more likely to have histories of myocardial infarction, hypertension and diabetes, the major indications for ACE inhibitors. Age, gender, on-treatment plasma lipids and use of other medications including statins were similar in the two groups. The progression rates were not different in patients having and not having ACE inhibitors (Table⇓). Mutlivariable analysis with adjustments for histories of myocardial infarction, hypertension and diabetes did not change the results.
Conclusion: ACE inhibitors do not alter the progression rate of coronary atherosclerosis. The reduction of mortality with these agents may involve other mechanisms such as prevention of plaque rupture through their hemodynamic effects. The hypothesis that ACE inhibitors have a direct coronary anti-atherosclerotic effect remains unproven.