Abstract 4192: Tissue ACE Inhibitors for Secondary Prevention of Adverse Cardiovascular Events in Patients with Preserved Left Ventricular Function: A Pooled Meta-Analysis

Abstract

Introduction: Although the role of angiotensin converting enzyme (ACE) inhibitors in patients with depressed left ventricular function is well established, their role in patients with preserved ventricular function is uncertain. We conducted a meta-analysis of recent clinical trials to evaluate the role of tissue ACE inhibitors in secondary prevention of cardiovascular disease in patients with preserved left ventricular function. Study Selection: Randomized placebo-controlled clinical trials of at least 12 months duration, conducted in patients who had experienced an acute cardiovascular event or were at high risk for cardiovascular events. Data Synthesis and Analysis: A total of 31,555 patients from 4 selected trials were analyzed. Relative risk estimations were made using pooled data from the 4 trials. Statistical significance was determined using the Chi-square test (two-sided alpha error <0.05). Results: When compared to placebo, the use of tissue ACE inhibitors was associated with significant relative risk reductions in all-cause mortality (p<0.001), cardiovascular mortality (p<0.001), fatal & non-fatal myocardial infarction (p<0.001) and stroke (p<0.001), as well as hospitalization for congestive heart failure (p=0.001) & occurrence of new-onset diabetes mellitus (p<0.001). The need for invasive coronary revascularization was also reduced (p<0.03), but the risk of hospitalization for angina was not significantly affected. Conclusion: Tissue ACE inhibitors decrease mortality and cardiovascular morbidity in high risk patients with cardiovascular disease and preserved left ventricular function in randomized placebo-controlled clinical trials.