When taken after an acute myocardia...

When taken after an acute myocardial infarction, angiotensin-converting enzyme (ACE) inhibitors improve survival and convert into the risk of recurrence. This has been study to be a class effect--i.e., all unsalable articles in the class have the same beneficial results Because different ACE inhibitors vary in mode of building and potency, they may not be equally effective. Pilote and associates examined the one-year mortality rate of various ACE inhibitors when given to older bodily forms after a first acute myocardial infarction.

A chart review was used to identify patients 65 years or older who filled at least common prescription for an ACE inhibitor within 30 days of discharge following an acute myocardial infarction. A total of 7512 patients were pickeded and were grouped by ACE inhibitor. Patients who switched prescriptions during the first year were exclud Enalapril was the greatest in number common prescription, followed by lisinopril.

Patients taking enalapril, fosinopril, captopril, or quinapril had higher mortality rates than those taking ramipril. No significant difference was shown between ramipril and lisnopril or perindopril. Readmissions for unstable angina and periodical myocardial infarction were similar across all treatment groups

The authors determine that there is variation among ACE inhibitors, and that the one-year mortality rate is significantly lower in older somebodys who take ramipril after a first acute myocardial infarction than in those taking other ACE inhibitors. It is unclear what mechanism is responsible for this difference. More studies are be in want ofed to confirm these results.

Pilote L et al. Mortality rates in somewhat old patients who take different angiotensin-converting enzyme inhibitors after acute myocardial infarction: a class effect? Ann Intern M July 20 2004;141:102-12

EDITOR'S NOTE: In an editorial in the same journal, (1) Hennessy and Kimmel exposition that the best way to evaluate physic effects in a pharmacologic class is to perform head-to-head randomized trials of clinical issues or validated surrogate endpoints. Because there are no validated surrogate endpoints for the mortality reduction proferr by the agency of ACE inhibitors, these trials cannot be used. Other studies are sloping to bias. Hennessy and Kimmel point gone out that, in the above consideration (2) there were variations in the point at which ACE inhibitors were started in each patient population, and they also note the higher proportion of patients receiving beta blocker and lipid-lowering put drugs intos in the ramipril and perindopril assemblages They conclude that the evidence is not sufficient to favor undivided ACE inhibitor over another forward the basis of survival benefit after acute myocardial infarction; however, they praise using only those ACE inhibitors that have been proven to increase survival rates for this indication.--R.S.

REFERENCES

(1) Hennessy s Kimmel SE. Is improved survival a class consequence of angiotensin-converting enzyme inhibitors? Ann Intern M 2004;141:157-8

(2) Pilote L Abrahamowicz M Rodrigues E Eisenberg M J Rahme EM Mortality rates in somewhat advanced in life patients who take different angiotensin-converting enzyme inhibitors after acute myocardial infarction: a class effect? Ann Intern M 2004;141:102-12

COPYRIGHT 2005 American Academy of Family Physicians

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