When it comes to preventing heart
attacks, people with the crushing chest pain known as angina may benefit from
taking an ACE inhibitor drug in addition to having angioplasty, researchers
report.
Typically, angina patients have one treatment or the other -- but not both,
according to a report in the March 15th issue of Journal of the American College
of Cardiology.
ACE (angiotensin-converting enzyme) inhibitors are drugs that widen blood
vessels, increasing blood supply to the heart, and angioplasty is an
artery-clearing procedure in which a balloon-tipped catheter is threaded into a
blocked artery and inflated, flattening fatty plaques against the artery wall.
While angioplasty helps many people with angina, those who also have a
poorly functioning left ventricle, the major pumping chamber of the heart, do
not tend to do as well.
In a new study, 159 people with angina and a moderately dysfunctional left
ventricle underwent angioplasty to restore blood flow to the heart. Afterwards,
participants took either the ACE inhibitor ramipril or a ('dummy') placebo pill
each day, according to a team of researchers led by Dr. Lars Kjoller-Hansen, of
the Rigshospitalet in Copenhagen, Denmark.
After an average of nearly 3 years, treatment with ACE inhibitors did not
significantly reduce the risk of chest pain compared with the placebo. However,
the risk of dying a cardiac-related death was lower in those taking ramipril.
Overall, one patient taking ramipril died a heart-related death during the
study compared with seven patients taking a placebo, according to the study,
which was funded in part by the AstaZeneca pharmaceutical company.
Based on the results, the researchers recommend that people with angina and
a moderately dysfunctional left ventricle be considered for long-term treatment
with ACE inhibitors after surgery. An expert not involved in the research agreed
that more people might benefit from the drugs than are currently taking them.
"This was a small study, but the results are certainly consistent with those
of larger studies," Dr. Bertram Pitt, of the University of Michigan School of
Medicine in Ann Arbor, said in a statement issued by the journal. "The results
suggest that everybody with coronary artery disease should probably be on an ACE
inhibitor such as ramipril."
