SOCIOECONOMIC ASPECTS OF ACE-INHIBITION IN THE SECONDARY PREVENTION IN CARDIOVASCULAR-DISEASES

Cardiovascular diseases are the leading causes of morbidity and mortal ity in the industrialized world and have become a major economic burde n. Therefore, not only ethical and medical but also economic reasons s uggest more intense efforts in primary and secondary prevention of car diovascular and, especially, coronary artery disease. The prevention o f the progression of heart failure and of the risks inherent in left v entricular dysfunction, including development of heart failure, reinfa rctions, and death, are major cornerstones in the ambitious but econom ically balanced use of our resources. Major trials in chronic heart fa ilure as well as the angiotensin-converting enzyme inhibitor pooling p roject in heart failure of all major studies have shown almost uniform ly a reduction in hospitalizations attributable to slowing of the prog ression of the disease. In the Munich Mild Heart Failure Trial (MHFT) socioeconomic analysis confirmed the high economic burden of progressi on to the end-stages of disease. Patients with progressive heart failu re had a four- to fivefold increase in hospital costs. The blunting of the progressive course of heart failure was effective enough to offse t the costs of drug treatment with captopril in an analysis extrapolat ing the results of the socioeconomic analysis to the total trial popul ation. Favorable results in preventive treatment of patients with asym ptomatic left ventricular dysfunction, hypertension, and diabetic neph ropathy also suggest that part of the additional costs of medication i s outweighed by fewer hospitalizations and interventions. Thus in many cardiovascular diseases angiotensin-converting enzyme inhibitors have a favorable cost-benefit ratio and can be recommended for broader use .