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Original Article
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Volume 351:2058-2068 November 11, 2004 Number 20
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Angiotensin-Converting–Enzyme Inhibition in Stable Coronary Artery Disease
The PEACE Trial Investigators

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ABSTRACT

Background Angiotensin-converting–enzyme (ACE) inhibitors are effective in reducing the risk of heart failure, myocardial infarction, and death from cardiovascular causes in patients with left ventricular systolic dysfunction or heart failure. ACE inhibitors have also been shown to reduce atherosclerotic complications in patients who have vascular disease without heart failure.

Methods In the Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial, we tested the hypothesis that patients with stable coronary artery disease and normal or slightly reduced left ventricular function derive therapeutic benefit from the addition of ACE inhibitors to modern conventional therapy. The trial was a double-blind, placebo-controlled study in which 8290 patients were randomly assigned to receive either trandolapril at a target dose of 4 mg per day (4158 patients) or matching placebo (4132 patients).

Results The mean (±SD) age of the patients was 64±8 years, the mean blood pressure 133±17/78±10 mm Hg, and the mean left ventricular ejection fraction 58±9 percent. The patients received intensive treatment, with 72 percent having previously undergone coronary revascularization and 70 percent receiving lipid-lowering drugs. The incidence of the primary end point — death from cardiovascular causes, myocardial infarction, or coronary revascularization — was 21.9 percent in the trandolapril group, as compared with 22.5 percent in the placebo group (hazard ratio in the trandolapril group, 0.96; 95 percent confidence interval, 0.88 to 1.06; P=0.43) over a median follow-up period of 4.8 years.

Conclusions In patients with stable coronary heart disease and preserved left ventricular function who are receiving "current standard" therapy and in whom the rate of cardiovascular events is lower than in previous trials of ACE inhibitors in patients with vascular disease, there is no evidence that the addition of an ACE inhibitor provides further benefit in terms of death from cardiovascular causes, myocardial infarction, or coronary revascularization.


Source Information

The writing committee for the Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial (Eugene Braunwald, M.D., Harvard Medical School and Brigham and Women's Hospital, Boston; Michael J. Domanski, M.D., National Heart, Lung, and Blood Institute, Bethesda, Md.; Sarah E. Fowler, Ph.D., George Washington University, Rockville, Md.; Nancy L. Geller, Ph.D., National Heart, Lung, and Blood Institute; Bernard J. Gersh, M.D., Mayo Clinic Foundation, Rochester, Minn.; Judith Hsia, M.D., George Washington University, Washington, D.C.; Marc A. Pfeffer, M.D., Ph.D., Harvard Medical School and Brigham and Women's Hospital; Madeline M. Rice, Ph.D., George Washington University, Rockville, Md.; Yves D. Rosenberg, M.D., National Heart, Lung, and Blood Institute; and Jean L. Rouleau, M.D., University of Montreal, Montreal) takes responsibility for the content of this article.

Address reprint requests to Dr. Braunwald at the TIMI Study Group, Brigham and Women's Hospital, 350 Longwood Ave., Boston, MA 02115.

Full Text of this Article


Related Letters:

ACE Inhibition in Stable Coronary Artery Disease
Yusuf S., Pogue J., Myers M. G., McCullough C., Pfeffer M. A., Domanski M. J., Braunwald E.
Extract | Full Text | PDF  
N Engl J Med 2005; 352:937-939, Mar 3, 2005. Correspondence

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