CARDIOPROTECTIVE EFFECT OF ANGIOTENSIN-CONVERTING ENZYME-INHIBITORS IN PATIENTS WITH CORONARY-ARTERY DISEASE

Clinical and experiments study with angiotensin-converting enzyme (ACE ) inhibitors suggest that these agents may improve coronary artery dis ease by acting at multiple sites in the series of events leading to en d-stage heart disease. These agents reduce blood pressure, improve pro gnosis and symptoms in patients with severe heart failure and in patie nts after acute myocardial infarction with left ventricular dysfunctio n. They are useful in the early, acute phase of myocardial infarction. More recently, ACE inhibitors have been shown to reduce in vitro vasc ular hypertrophy, to attenuate arteriosclerosis, and to maintain endot helium function, Whether these effects occur at clinical levels is sti ll uncertain. The exciting clinical data have led to the proposal that alteration of ACE activity, particularly in tissue, is an important f actor in development and progression of CAD. The ACE system is complex , with endocrine, paracrine, and autocrine effects. ACE is present in cardiac and vascular tissue, Therefore, the beneficial effects of ACE inhibitors can be classified as ''cardio'' and ''vasculo'' protective. This article summarizes a number of independent and complementary mec hanisms pointing to a role of ACE and ACE inhibition in coronary arter y disease.