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Журнал "Кардиология" №5, 2007

Антиатерогенные эффекты ингибиторов ангиотензинпревращающего фермента с точки зрения доказательной медицины. Часть II

Antiatherogenic Effects of Angiotensin Converting Enzyme Inhibitors From the Point of View of Evidence Based Medicine

In a series of articles the authors analyze literature data concerning controlled studies in which cardio-, cerebro-, and vasoprotective effects of angiotensin converting enzyme inhibitors (ACEI) have been assessed. In the second communication they discuss the results of three recently completed major randomized placebo controlled trials assessing effect of ACEI on the risk of cardiovascular events in patients with chronic ischemic heart disease (IHD) and preserved left ventricular systolic function. In PROGRESS and PEACE trials ACEI perindopril and trandolapril as monotherapy turned out incapable to prevent development of myocardial infarctions and strokes in patients with cardiovascular diseases without left ventricular systolic dysfunction. In EUROPA positive results were achieved at the account of special selection of patients, post hoc replacement of end points, and the use of high dose of perindopril (8 mg/day). Therefore results of this trial can not be applied to majority of patients with IHD. Biochemical studies have shown that ACEI are unable to suppress angiotensin II formation in human heart and vessels and thus in principle are not capable to cause cardio- and vasoprotective effects independent of their antihypertensive action. The fact is that contrary to rats in human heart and vessels angiotensin converting enzyme is responsible for just a portion (2–20% and 40%, respectively), of entire angiotensin II production. The remaining part of angiotensin II is formed under influence of chymase, activity of which is not altered during treatment with ACEI.

Keywords: angiotensin converting enzyme inhibitors; ramipril; perindopril; ischemic heart disease; stroke; cardiovascular risk; chymase; angiotensin converting enzyme-2.

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