Angiotensin-Converting-Enzyme Inhibition in Stable Coronary Artery Disease

doi:10.1056/NEJMoa042739

Volume 351:2058-2068		November 11, 2004		Number 20

Angiotensin-Converting–Enzyme Inhibition in Stable Coronary Artery Disease

The PEACE Trial Investigators

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by Pitt, B.

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ABSTRACT

Background Angiotensin-converting–enzyme (ACE) inhibitorsare effective in reducing the risk of heart failure, myocardialinfarction, and death from cardiovascular causes in patientswith left ventricular systolic dysfunction or heart failure.ACE inhibitors have also been shown to reduce atheroscleroticcomplications in patients who have vascular disease withoutheart failure.

Methods In the Prevention of Events with Angiotensin ConvertingEnzyme Inhibition (PEACE) Trial, we tested the hypothesis thatpatients with stable coronary artery disease and normal or slightlyreduced left ventricular function derive therapeutic benefitfrom the addition of ACE inhibitors to modern conventional therapy.The trial was a double-blind, placebo-controlled study in which8290 patients were randomly assigned to receive either trandolaprilat a target dose of 4 mg per day (4158 patients) or matchingplacebo (4132 patients).

Results The mean (±SD) age of the patients was 64±8years, the mean blood pressure 133±17/78±10 mmHg, and the mean left ventricular ejection fraction 58±9percent. The patients received intensive treatment, with 72percent having previously undergone coronary revascularizationand 70 percent receiving lipid-lowering drugs. The incidenceof the primary end point — death from cardiovascular causes,myocardial infarction, or coronary revascularization —was 21.9 percent in the trandolapril group, as compared with22.5 percent in the placebo group (hazard ratio in the trandolaprilgroup, 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 andpreserved left ventricular function who are receiving "currentstandard" therapy and in whom the rate of cardiovascular eventsis lower than in previous trials of ACE inhibitors in patientswith vascular disease, there is no evidence that the additionof an ACE inhibitor provides further benefit in terms of deathfrom cardiovascular causes, myocardial infarction, or coronaryrevascularization.

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.

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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.
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N Engl J Med 2005; 352:937-939, Mar 3, 2005. Correspondence

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